Provider Demographics
NPI:1477800498
Name:PETERS - LOWE, KISHA DANITA (MS SLP)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:DANITA
Last Name:PETERS - LOWE
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TALMADGE ST
Mailing Address - Street 2:STOP 2
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1769
Mailing Address - Country:US
Mailing Address - Phone:845-705-9188
Mailing Address - Fax:
Practice Address - Street 1:11 TALMADGE ST
Practice Address - Street 2:STOP 2
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1769
Practice Address - Country:US
Practice Address - Phone:845-705-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist