NPI age
19 years
Enumerated 2007-01-29
● Active
Type 1 · Individual
DR. Eliza S. Petersen, AUD, CCCA
Petersen is 1 of 2 audiologist providers in Driggs and 1 of 146 in Idaho.
Primary specialty
Audiologist
Plus 1 subspecialty
Licensed in
ID, WY
2 states
Status
Active
No deactivations on record
Last NPPES update
2023-04-19
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 146 active audiologist providers in Idaho.
NPI age
19 years
↑ 5 yr above median (14 yr)
State licenses
2 states
Top 87% — 12% of peers are multi-state
Subspecialties
0
26% of peers hold subspecialties
NPI lifetime · 2007 → 2026
2007-01Enumerated in NPPES
2007
2026
Where they practice
Practice location
2740 Shadowmoon Ln Ste 417
Driggs, ID 834225083
Mailing address
1388 Mount Moriah Rd
Livermore, CO 805369311
Specialties
-
Audiologist Primary(1) A specialist in evaluation, habilitation and rehabilitation of those whose communication disorders center in whole or in part in hearing function. Audiologists are autonomous professionals who identify, assess, and manage disorders...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 807694600 | |
| 05 (WY) | 125563100 |
Multi-state credentialing: Licensed in 2 states. Useful context for credentialers building cross-state provider networks.
Practice context
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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