Provider Demographics
NPI:1992437792
Name:PETERS, EMILY R (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:PETERS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:R
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4211 GOVERNORS BLVD APT G
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-4020
Mailing Address - Country:US
Mailing Address - Phone:219-688-5415
Mailing Address - Fax:
Practice Address - Street 1:1415 LWW
Practice Address - Street 2:STE. M.
Practice Address - City:OSCELOA
Practice Address - State:IN
Practice Address - Zip Code:46561
Practice Address - Country:US
Practice Address - Phone:574-675-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007795A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist