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General NPI Number Information
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NPI Number | 1740688712
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Entity Type | Individual
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Provider Name | CHELSEA PETERSON SLP
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Gender | Female
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 4220 80TH ST NE
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City | MARYSVILLE
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State | WA
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Zip | 98270-3423
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Country | US
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Telephone | 360-653-7058
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 114TH ST NE
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City | TULALIP
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State | WA
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Zip | 98271-9401
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Country | US
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Telephone | 425-791-2240
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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 | LL 60517307
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License Number State | WA
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