Provider Demographics
NPI:1598936882
Name:PETERSEN, LINDA LOUISE (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOUISE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
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Mailing Address - Street 1:2300 MAPLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4362
Mailing Address - Country:US
Mailing Address - Phone:501-227-5725
Mailing Address - Fax:501-219-2781
Practice Address - Street 1:11517 KANIS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3724
Practice Address - Country:US
Practice Address - Phone:501-993-8707
Practice Address - Fax:501-223-8075
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARSP# 324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist