Active NPI
Renae Peter, M.S, SLP-CCC
- Speech-Language Pathologist
- Marion, IL
National Provider Identifier
1003174178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146010152
- Practice address
- 12363 Laguna Dr
Marion, IL 62959-9040 - Phone
- (618) 263-2385
- NPI assigned
- Apr 26, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146010152 | IL | Primary |
Addresses
Primary practice location
12363 Laguna Dr
Marion, IL 62959-9040
Mailing address
12363 Laguna Dr
Marion, IL 62959-9040
Phone (618) 263-2385
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146010152 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335398400000",
"number": "1003174178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12363 LAGUNA DR",
"city": "MARION",
"state": "IL",
"postal_code": "629599040",
"telephone_number": "618-263-2385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12363 LAGUNA DR",
"city": "MARION",
"state": "IL",
"postal_code": "629599040",
"telephone_number": "618-263-2385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETER",
"first_name": "RENAE",
"name_prefix": "Ms.",
"credential": "M.S, SLP-CCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-04-26",
"last_updated": "2012-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146010152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marion, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.