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General NPI Number Information
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NPI Number | 1346455268
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Entity Type | Individual
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Provider Name | PATRICIA M. PETERS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4502 STARKEY RD SUITE #207
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City | ROANOKE
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State | VA
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Zip | 24018-8541
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Country | US
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Telephone | 540-772-0588
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Fax | 540-772-0592
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Provider Business Mailing Address
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Address Line | 4502 STARKEY RD SUITE #207
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City | ROANOKE
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State | VA
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Zip | 24018-8541
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Country | US
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Telephone | 540-772-0588
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Fax | 540-772-0592
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202-000581
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License Number State | VA
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