Provider Demographics
NPI:1023434966
Name:PETERSON, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:ZACHARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 W 123RD AVE
Mailing Address - Street 2:#3423
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-1818
Mailing Address - Country:US
Mailing Address - Phone:713-553-3770
Mailing Address - Fax:
Practice Address - Street 1:500 W 123RD AVE
Practice Address - Street 2:#3423
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1818
Practice Address - Country:US
Practice Address - Phone:713-553-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist