Provider Demographics
NPI:1124816327
Name:PETERSON, CALEB ELDON (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:CALEB
Middle Name:ELDON
Last Name:PETERSON
Suffix:
Gender:
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E OSBORN RD APT 116
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5214
Mailing Address - Country:US
Mailing Address - Phone:520-240-4165
Mailing Address - Fax:
Practice Address - Street 1:4439 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4139
Practice Address - Country:US
Practice Address - Phone:480-658-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP15364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist