Healthcare Provider Details

I. General information

NPI: 1144529165
Provider Name (Legal Business Name): JOY PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH ST & CIVIC CENTER BLVD THE CHILDREN'S HOSPITAL OF PHILADELPHIA - AUDIOLOGY
PHILADELPHIA PA
19144
US

IV. Provider business mailing address

34 ST & CIVIC CENTER BLVD THE CHILDREN'S HOSPITAL OF PHILADELPHIA - AUDIOLOGY
PHILADELPHIA PA
19144
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-7620
  • Fax: 215-590-5641
Mailing address:
  • Phone: 215-590-7620
  • Fax: 215-590-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT001011L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00053200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number25MG00086900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: