Provider Demographics
NPI:1508105669
Name:PETERSEN, LEAH CHRISTINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:CHRISTINE
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 1:2750 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6909
Mailing Address - Country:US
Mailing Address - Phone:202-667-9490
Mailing Address - Fax:202-667-9493
Practice Address - Street 1:2750 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6909
Practice Address - Country:US
Practice Address - Phone:202-667-9490
Practice Address - Fax:202-667-9493
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist