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NPI Code Detail

MEDICARE: MARCELLINE CHRISTINE CRUZ PETERSON MS, CCC-SLP

MEDICARE: MARCELLINE CHRISTINE CRUZ PETERSON MS, 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
1235Z00000XSpeech-Language Pathologist1786-154WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437326030
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCELLINE CHRISTINE CRUZ PETERSON MS, CCC-SLP
Provider Business Mailing Address
First Line : 801 S KLEIN DR
Second Line :
City : WAUNAKEE
State : WI
Zip : 53597-1575
Country : US
Telephone Number : 608-849-5016
Fax Number : 608-849-6516
Provider Business Practice Location Address
First Line : 801 S KLEIN DR
Second Line :
City : WAUNAKEE
State : WI
Zip : 53597-1575
Country : US
Telephone Number : 608-849-5016
Fax Number : 608-849-6516
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2008
Last Update Date : 05/13/2008

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