Individual
KIMBERLY PAIGE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
78 HOSPITAL RD, MACON, MS 39341-2490
(662) 726-4231
Mailing address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S4267
MS
Other
Enumeration date
09/26/2017
Last updated
09/26/2017
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