Provider Demographics
NPI:1043985427
Name:PETERSON, MEREDITH JOAN (MA/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JOAN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 ASHTON PARK
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-1854
Mailing Address - Country:US
Mailing Address - Phone:662-435-0817
Mailing Address - Fax:
Practice Address - Street 1:660 MCQUEEN SMITH RD N STE H
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7559
Practice Address - Country:US
Practice Address - Phone:334-350-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5004OtherALABAMA BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY