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General NPI Number Information
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NPI Number | 1407079205
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Entity Type | Organization
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Legal Business Name | KRISTIN M. PETERSON LTD
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 1733 W IRVING PARK RD # 321
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City | CHICAGO
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State | IL
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Zip | 60613-2500
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Country | US
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Telephone | 773-983-2118
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Fax |
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Provider Business Mailing Address
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Address Line | 1733 W IRVING PARK RD # 321
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City | CHICAGO
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State | IL
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Zip | 60613-2500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | KRISTIN PETERSON
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Credential | M.S. CCC-SLP
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Telephone | 773-983-2118
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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 | 146005279
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License Number State | IL
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