Provider Demographics
NPI:1235172198
Name:PETERSON, NANCY E (MED,CCC-A)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:E
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MED,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GROVE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7797
Mailing Address - Country:US
Mailing Address - Phone:781-235-8110
Mailing Address - Fax:781-235-8110
Practice Address - Street 1:8 GROVE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7797
Practice Address - Country:US
Practice Address - Phone:781-235-8110
Practice Address - Fax:781-235-8110
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAD0081OtherBCBSMA
MAPE041364Medicare ID - Type Unspecified