Provider Demographics
NPI:1982844965
Name:PETERKIN, KRISTINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:PETERKIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10791 S 72ND ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3423
Mailing Address - Country:US
Mailing Address - Phone:402-932-2782
Mailing Address - Fax:402-932-2705
Practice Address - Street 1:10791 S 72ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3423
Practice Address - Country:US
Practice Address - Phone:402-932-2782
Practice Address - Fax:402-932-2705
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist