Provider Demographics
NPI:1801138862
Name:PETERSON, DANA NICOLE (SLP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:NICOLE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W 43RD ST
Mailing Address - Street 2:S14A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6410
Mailing Address - Country:US
Mailing Address - Phone:646-283-0789
Mailing Address - Fax:
Practice Address - Street 1:360 W 43RD ST
Practice Address - Street 2:S14A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6410
Practice Address - Country:US
Practice Address - Phone:646-283-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist