| NPI | 1750512653 |
|---|---|
| Former Name | TIFFANY COLLEEN PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TN 6625) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: KS 2999) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2019-01-23 |