Provider Demographics
NPI:1831216241
Name:PETERS, ADRIENNE MELITA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:MELITA
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4041
Mailing Address - Country:US
Mailing Address - Phone:717-917-0467
Mailing Address - Fax:
Practice Address - Street 1:336 S WEST END AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-5043
Practice Address - Country:US
Practice Address - Phone:717-393-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006335L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist