Provider Demographics
NPI:1295090595
Name:PETERSEN, ASHLEY ROSEMARIE (MS)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ROSEMARIE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 N 360 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1372
Mailing Address - Country:US
Mailing Address - Phone:916-690-2558
Mailing Address - Fax:
Practice Address - Street 1:3300 RUNNING CREEK WAY
Practice Address - Street 2:BUILDING B SUITE 150
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5563
Practice Address - Country:US
Practice Address - Phone:801-766-4244
Practice Address - Fax:801-776-4245
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8341022-4104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist