Provider Demographics
NPI:1134570294
Name:PETERSON, BRITTANY MARIE (MS SLP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MARIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CEDAR TER
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4302
Mailing Address - Country:US
Mailing Address - Phone:617-797-6486
Mailing Address - Fax:
Practice Address - Street 1:44 CEDAR TER
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-4302
Practice Address - Country:US
Practice Address - Phone:617-797-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-9930-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist