Basic Information
| Provider Information | |||||||||
| NPI: | 1003154865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | FELICIA | ||||||||
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| Credential: | MS CCC SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26850 S BAY DR | ||||||||
| Address2: | |||||||||
| City: | BONITA SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341344379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399482600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26850 S BAY DR | ||||||||
| Address2: | |||||||||
| City: | BONITA SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341344379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399482600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2013 | ||||||||
| LastUpdateDate: | 01/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA 11906 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.