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General NPI Number Information
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NPI Number | 1285921486
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Entity Type | Individual
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Provider Name | KATHLEEN E PETERSON DOCTOR OF AUDIOLOGY
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Gender | Female
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Dates
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Enumeration Date | 07/08/2011
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 975 S. MYRTLE AVE.
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City | TEMPE
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State | AZ
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Zip | 85257
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Country | US
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Telephone | 480-965-2373
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Fax | 480-965-0076
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Provider Business Mailing Address
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Address Line | 975 S. MYRTLE AVE.
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City | TEMPE
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State | AZ
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Zip | 85257
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Country | US
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Telephone | 480-965-2373
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Fax | 480-965-0076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | DA348
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License Number State | AZ
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