Individual
KRISTA KELLY PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6200 XERXES AVE S, EDINA, MN 55423-1033
(952) 925-8500
Mailing address
104 FAIRWAY DR, GLENCOE, MN 55336-3214
(952) 465-7636
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8918
MN
Other
Enumeration date
06/28/2021
Last updated
06/28/2021
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