Provider Demographics
NPI:1659159689
Name:PETERSEN, MARGOT PATRICIA (CFY-SLP)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:PATRICIA
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3807
Mailing Address - Country:US
Mailing Address - Phone:631-521-3965
Mailing Address - Fax:
Practice Address - Street 1:132 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-3807
Practice Address - Country:US
Practice Address - Phone:631-521-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist