Provider Demographics
NPI:1154100402
Name:PETERS, MAKANI ELEANOR (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAKANI
Middle Name:ELEANOR
Last Name:PETERS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W 75TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1744
Mailing Address - Country:US
Mailing Address - Phone:715-252-5303
Mailing Address - Fax:
Practice Address - Street 1:1401 GLACIER AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5135
Practice Address - Country:US
Practice Address - Phone:301-817-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist