Individual
MRS. LISA OELHAFEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
10516 PARK RD, CHARLOTTE, NC 28210-8405
(704) 541-9080
(704) 542-0699
Mailing address
4315 FAIRVIEW OAK LN, CHARLOTTE, NC 28211-4922
(704) 366-6447
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5121
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7411683
—
NC
Enumeration date
03/14/2006
Last updated
03/07/2013
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