Provider Demographics
NPI:1043977457
Name:PETERSEN, DANIELLE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:DR
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:1 CHILDRENS WAY # 113
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1399
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY # 113
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN518158231H00000X
AR202148231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR202148OtherAR STATE LICENSURE
MN518158OtherMN DEPT OF HEALTH HEALTH OCCUPATIONS PROGRAM