IndividualActive
Mary Petersen, MA, CCC-SLP
NPI 1063661916 · Speech-Language Pathologist · Newcastle, WY
Provider details
- NPI number
- 1063661916
- Entity type
- Individual
- Primary specialty
- Speech-Language PathologistSpeech, Language and Hearing Service Providers
- Credential
- MA, CCC-SLP
- Sex
- Female
- Sole proprietor
- Yes
- License
- #SP-391 (WY)
Mailing address
104 Stampede St
Newcastle, WY 82701-3037
Registry dates
- Enumerated
- 2008-09-16
- Last updated
- 2017-02-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.