Provider Demographics
NPI:1619135399
Name:PETERS, MARY LOVE (M,S, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOVE
Last Name:PETERS
Suffix:
Gender:F
Credentials:M,S, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9214 EMINENCE CT
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7602
Mailing Address - Country:US
Mailing Address - Phone:502-425-4283
Mailing Address - Fax:
Practice Address - Street 1:9214 EMINENCE CT
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7602
Practice Address - Country:US
Practice Address - Phone:502-425-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2597235Z00000X
TN2481235Z00000X
KY3540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist