Provider Demographics
NPI:1003191024
Name:PETERSON, MEGAN RENEE (AAS-HIS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:AAS-HIS
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RENEE
Other - Last Name:REEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 N ADKINS DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9056
Mailing Address - Country:US
Mailing Address - Phone:208-446-7679
Mailing Address - Fax:
Practice Address - Street 1:9211 E MISSION AVE STE G
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4096
Practice Address - Country:US
Practice Address - Phone:509-323-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA 60206077237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist