Kylie Peterson, MA CCC-SLP

Primary specialty

Speech/Language/Hearing Specialist/TechnologistTaxonomy code 235500000X

Practice address

1609 W Elm St Ste B
El Reno, OK 73036-4261

Phone

(405) 467-6782

Fax

(405) 467-6100

NPI assigned

May 31, 2023

Last updated

Sep 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Complete Rehab, LLC

  dba Oklahoma Pediatric Therapy Center

  • Rehabilitation Clinic/Center
  • Yukon, OK
  • NPI 1497178156

  Speech-Language Pathologist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1033802426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 COMMONS CIR STE B",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730999538",
            "telephone_number": "405-467-6782",
            "fax_number": "405-467-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W ELM ST STE B",
            "city": "EL RENO",
            "state": "OK",
            "postal_code": "730364261",
            "telephone_number": "405-467-6782",
            "fax_number": "405-467-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KYLIE",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-31",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235500000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randall Keith Pemberton, BA, BHRS
• Roxana Jean Pennel
• Molly Perkins, MS LPC
• Ez Perry
• Kristina Love Peterson
• Melissa Picchione
• Stacy Beth Pierce, M.ED
• Tilly Pinto
• Geoffrey E Pirtle, D.C.
• Kristal Diane Pointer

• Speech/Language/Hearing Specialist/Technologist in El Reno, OK
• Providers in El Reno, OK by specialty
• Speech/Language/Hearing Specialist/Technologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.