Provider Demographics
NPI:1346591153
Name:PETERSEN, KARRIE JANAE (MS, CCC- SLP)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:JANAE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MS, CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2963
Mailing Address - Country:US
Mailing Address - Phone:360-230-8557
Mailing Address - Fax:888-915-0898
Practice Address - Street 1:1220 MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2963
Practice Address - Country:US
Practice Address - Phone:360-230-8557
Practice Address - Fax:888-915-0898
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60302449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist