Individual
HAYLEY ROSE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC SLP
Contact information
Practice address
3027 S NEW HAVEN AVE, TULSA, OK 74114-6131
(918) 746-8763
Mailing address
3027 S NEW HAVEN AVE, TULSA, OK 74114-6131
(918) 746-8763
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5173
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5173
STATE LICENSE
OK
Enumeration date
08/19/2019
Last updated
08/19/2019
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