Provider Demographics
NPI:1184925729
Name:PETERSON, BRITTNEY JILL (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRITTNEY
Middle Name:JILL
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:BRITTNEY
Other - Middle Name:JILL
Other - Last Name:KOPECKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:845 S MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-6116
Mailing Address - Country:US
Mailing Address - Phone:920-322-0447
Mailing Address - Fax:
Practice Address - Street 1:845 S MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-6116
Practice Address - Country:US
Practice Address - Phone:920-322-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154-3939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist