Provider Demographics
NPI:1447217062
Name:PETERSON, DENNIS A (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:A
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2052
Mailing Address - Country:US
Mailing Address - Phone:724-349-5070
Mailing Address - Fax:724-349-8368
Practice Address - Street 1:78 TUSCARAWAS RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2231
Practice Address - Country:US
Practice Address - Phone:724-728-3659
Practice Address - Fax:724-728-3679
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000235L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
R06744Medicare UPIN
PA360571OtherHIGHMARK BCBS
PA1036036OtherGATEWAY
PA89563OtherUNISON
PA250221OtherUPMC
PA284291Medicare ID - Type Unspecified
PA1576172Medicaid