Individual
JODY PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21 SACKVILLE ST UNIT A, CHARLESTOWN, MA 02129-2041
(856) 889-7310
Mailing address
21 SACKVILLE ST UNIT A, CHARLESTOWN, MA 02129-2041
(856) 889-7310
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL010621
PA
Other
Enumeration date
05/31/2012
Last updated
08/20/2020
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