Provider Demographics
NPI:1518041581
Name:PETERSEN, PAULA ELLEN (AU)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ELLEN
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:AU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WILSON ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-5094
Mailing Address - Country:US
Mailing Address - Phone:406-233-4327
Mailing Address - Fax:406-233-3985
Practice Address - Street 1:2600 WILSON ST
Practice Address - Street 2:SUITE #4
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-5094
Practice Address - Country:US
Practice Address - Phone:406-233-4327
Practice Address - Fax:406-233-3985
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist