Provider Demographics
NPI:1578909263
Name:PETERSON, CHRISTENE R (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTENE
Middle Name:R
Last Name:PETERSON
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 1:1046 BARNACLE DR
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2504
Mailing Address - Country:US
Mailing Address - Phone:609-978-2890
Mailing Address - Fax:
Practice Address - Street 1:1001 CENTER ST
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-1347
Practice Address - Country:US
Practice Address - Phone:609-857-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00610200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist