Provider Demographics
NPI:1831309178
Name:PETERSON, SHELLY RANEE (MA,NMT FELLOW,MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:RANEE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MA,NMT FELLOW,MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 SAWYERS DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2948
Mailing Address - Country:US
Mailing Address - Phone:515-494-4618
Mailing Address - Fax:
Practice Address - Street 1:4820 SAWYERS DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2948
Practice Address - Country:US
Practice Address - Phone:515-494-4618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN06272225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist