Provider Demographics
NPI:1669643664
Name:PETERSON, WILLIAM RICHARD (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RICHARD
Last Name:PETERSON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 NATIONS CROSSING RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1876
Mailing Address - Country:US
Mailing Address - Phone:704-522-1020
Mailing Address - Fax:704-522-1429
Practice Address - Street 1:5000 NATIONS CROSSING RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1876
Practice Address - Country:US
Practice Address - Phone:704-522-1020
Practice Address - Fax:704-522-1429
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC549237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist