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PETERSON SPEECH THERAPY

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Company Details

Name: PETERSON SPEECH THERAPY
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 05 Aug 2013 (12 years ago)
Entity Number: 500269
Place of Formation: IDAHO
File Number: 0000500269
ZIP code: 83401
County: Bonneville County
Mailing Address: 545 LINCOLN DR IDAHO FALLS, ID 83401

National Provider Identifier

NPI Number:
1497188387

Authorized Person:

Name:
MRS. MARISSA LYNNE PETERSON
Role:
SPEECH LANGUAGE PATHOLOGIST
Phone:

Taxonomy:

Selected Taxonomy:
235Z00000X - Speech-Language Pathologist
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0000500269 2013-08-05

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State