| NPI | 1982950366 |
|---|---|
| Former Name | AMANDA E PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: MA SP-9015-SL) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL010660) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2013-08-09 |