Individual
SARA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4102 SHORE DRIVE, INDIANAPOLIS, IN 46254
(317) 347-9051
Mailing address
4102 SHORE DR, INDIANAPOLIS, IN 46254-2608
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22006741A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003330165
ANTHEM BLUECROSS BLUESHIELD
—
Enumeration date
03/07/2018
Last updated
06/16/2018
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