Individual
ADRIENNE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
13302 47TH AVE SE, MILL CREEK, WA 98012-8970
(509) 720-7842
Mailing address
13302 47TH AVE SE, MILL CREEK, WA 98012-8970
(509) 720-7842
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL60320131
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010155758
BLUE SHIELD PROVIDER NUMB
ID
01
—
SPL02
BLUE CROSS PROVIDER NUMBE
ID
Enumeration date
02/12/2007
Last updated
11/17/2015
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