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Individual

ELIZABETH PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1429 DECATUR DR, CHARLOTTESVILLE, VA 22911-7499
(393) 931-9583
Mailing address
1429 DECATUR DR, CHARLOTTESVILLE, VA 22911-7499
(393) 931-9583

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202008993
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2202008993
VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
VA
Enumeration date
11/09/2018
Last updated
11/09/2018
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