Healthcare Provider Details

I. General information

NPI: 1982472189
Provider Name (Legal Business Name): MISS ALESSANDRA PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MICHELLE DRIVE
ST. CATHARINES ON
L2S 3G7
CA

IV. Provider business mailing address

17 MICHELLE DRIVE
ST. CATHARINES ON
L2S 3G7
CA

V. Phone/Fax

Practice location:
  • Phone: 289-214-8657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: