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General NPI Number Information
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NPI Number | 1710248141
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Entity Type | Individual
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Provider Name | ANNALISE PETERSON
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Gender | Female
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 820 E TERRA COTTA AVE
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-3649
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Country | US
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Telephone | 815-354-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 2361 CHESAPEAKE BAY
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City | ELGIN
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State | IL
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Zip | 60123-8578
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Country | US
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Telephone | 224-239-5260
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Fax |
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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 |
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License Number State | IL
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