Provider Demographics
NPI:1164406955
Name:PETERSON, MARY ELIZABETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:PETERSON-COMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1000 OAKLAND DR FL 3
Mailing Address - Street 2:WMU UNIFIED CLINICS CHARLES VAN RIPER LANGUAGE SPEECH
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1282
Mailing Address - Country:US
Mailing Address - Phone:269-387-7209
Mailing Address - Fax:269-387-7227
Practice Address - Street 1:1000 OAKLAND DR FL 3
Practice Address - Street 2:WMU UNIFIED CLINICS CHARLES VAN RIPER LANGUAGE SPEECH
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1282
Practice Address - Country:US
Practice Address - Phone:269-387-7209
Practice Address - Fax:269-387-7227
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist