MEDICARE: MR. CALEB ELDON PETERSON M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP16196	AZ

General Provider Information

NPI Number	:	1124816327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CALEB ELDON PETERSON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	4439 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4139
Country	:	US
Telephone Number	:	480-658-0698
Fax Number	:

Provider Business Practice Location Address
First Line	:	4439 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4139
Country	:	US
Telephone Number	:	480-658-0698
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	07/09/2025

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Directions to “ MR. CALEB ELDON PETERSON M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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