Individual
MARIAH JEAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1252 S AVONDALE BLVD, AVONDALE, AZ 85323-8900
(623) 936-6581
Mailing address
12115 W VAN BUREN ST APT 2122, AVONDALE, AZ 85323-7253
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP9470
AZ
Other
Enumeration date
08/04/2015
Last updated
08/04/2015
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