Provider Demographics
NPI:1447496211
Name:PETERSON, ARLENE
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ARLENE
Other - Middle Name:WASKO
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1231 PEACEABLE ST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3234
Mailing Address - Country:US
Mailing Address - Phone:518-882-9549
Mailing Address - Fax:
Practice Address - Street 1:1231 PEACEABLE ST
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-3234
Practice Address - Country:US
Practice Address - Phone:518-882-9549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000051-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist