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1669633590
MARISSA PETERSON
IDAHO FALLS, ID
NPI
1669633590
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
235Z00000X Speech-Language Pathologist
(Licence: ID SLP-1685)
Enumeration Date
2008-06-23
Last Update Date
2009-07-12
Business Address
MARISSA PETERSON MA/CCC-SLP
545 LINCOLN DR
IDAHO FALLS, ID 83401-4118
Phone number: 208-757-8553
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Mailing Address
MARISSA PETERSON MA/CCC-SLP
PO BOX 2943
IDAHO FALLS, ID 83403-2943
Phone number: 208-757-8553
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