Individual
KELLY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
81 E DILLON DR, TITUSVILLE, PA 16354-2402
(814) 827-2727
Mailing address
8796 ROUTE 219, BROCKWAY, PA 15824-6010
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL013217
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
813221954
—
PA
Enumeration date
03/03/2017
Last updated
03/03/2017
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