Healthcare Provider Details

I. General information

NPI: 1558279182
Provider Name (Legal Business Name): JANET MARIE FISH PETERSON MS-CCC, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 5TH ST NE
BEMIDJI MN
56601-4627
US

IV. Provider business mailing address

1617 5TH ST NE
BEMIDJI MN
56601-4627
US

V. Phone/Fax

Practice location:
  • Phone: 218-333-3250
  • Fax: 218-333-3480
Mailing address:
  • Phone: 218-333-3250
  • Fax: 218-333-3480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number357995
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: