Provider Demographics
NPI:1144529165
Name:PETERSON, JOY
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ST & CIVIC CENTER BLVD
Mailing Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA - AUDIOLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144
Mailing Address - Country:US
Mailing Address - Phone:215-590-7620
Mailing Address - Fax:215-590-5641
Practice Address - Street 1:34TH ST & CIVIC CENTER BLVD
Practice Address - Street 2:THE CHILDREN'S HOSPITAL OF PHILADELPHIA - AUDIOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144
Practice Address - Country:US
Practice Address - Phone:215-590-7620
Practice Address - Fax:215-590-5641
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT001011L231H00000X
NJ41YA00053200231H00000X
NJ25MG00086900237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter