Individual
JENNY-LYNNE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
420 NE 12TH ST, NEWPORT, OR 97365-2228
(541) 574-2240
Mailing address
420 NE 12TH ST, NEWPORT, OR 97365-2228
(541) 574-2240
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
015524
OR
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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