Provider Demographics
NPI:1215559380
Name:PETEREIN, TESSA F
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:F
Last Name:PETEREIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 DOOLING HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4276
Mailing Address - Country:US
Mailing Address - Phone:636-937-9188
Mailing Address - Fax:
Practice Address - Street 1:1250 DOOLING HOLLOW RD
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4276
Practice Address - Country:US
Practice Address - Phone:636-933-6959
Practice Address - Fax:636-937-9189
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist