Provider Demographics
NPI:1548444284
Name:PETERS, DENISE MICHELLE (SLP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MICHELLE
Last Name:PETERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MICHELLE
Other - Last Name:FRITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1489 W LACEY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5957
Mailing Address - Country:US
Mailing Address - Phone:559-585-8087
Mailing Address - Fax:
Practice Address - Street 1:1489 W LACEY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5957
Practice Address - Country:US
Practice Address - Phone:559-585-8087
Practice Address - Fax:559-585-1933
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist