Provider Demographics
NPI:1144369216
Name:PETERSEN-ZICH, YVONNE ELIZABETH (MS)
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:ELIZABETH
Last Name:PETERSEN-ZICH
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 1:4920 MARY DREW DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-9514
Mailing Address - Country:US
Mailing Address - Phone:262-721-0269
Mailing Address - Fax:
Practice Address - Street 1:3939 S 92ND ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-2140
Practice Address - Country:US
Practice Address - Phone:414-546-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI701-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist