Dr. Eliza S. Petersen, AUD, CCCA
Audiologist in Driggs, ID. Individual provider (NPI-1).
NPI number1083750996
StatusActive
Last updated in NPPESApr 19, 2023
Details
- NPI
- 1083750996
- Entity type
- Individual (NPI-1)
- Name
- Dr. Eliza S. Petersen
- Credential
- AUD, CCCA
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jan 29, 2007
- Certification date
- Apr 19, 2023
- Last updated
- Apr 19, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 231H00000X | Audiologist | AUD-1142 | ID | Yes |
| 231H00000X | Audiologist | A-974 | WY |
Other names
- Eliza Schwab (Former Name)
Practice location
2740 Shadowmoon Ln Ste 417Driggs, ID 83422-5083
Phone 307-745-5587 · Fax 877-515-1633
Mailing address
1388 Mount Moriah RdLivermore, CO 80536-9311
Phone 307-745-5587 · Fax 877-515-1633
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Audiologist providers in Driggs, ID
Checking a whole list?
Paste up to 5,000 NPIs and download status, name, taxonomy, license and address for each one. Useful for credentialing, billing and pharmacy claim checks.