Mallory Peterson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

2625 Barna Ave Ste H
Titusville, FL 32780-3417

Phone

(321) 362-4099

NPI assigned

May 30, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Mallory Petersons Speech Paradise LLC

  • Speech-Language Pathologist
  • Merritt Island, FL
  • NPI 1376332585
  NPD Authorized official
• Speechwise Therapy LLC

  • Speech-Language Pathologist
  • Titusville, FL
  • NPI 1992338792
  NPD

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

{
    "created_epoch": "1685404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685404800000",
    "number": "1104519867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 ROCHELLE PKWY",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329525650",
            "telephone_number": "321-615-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 BARNA AVE STE H",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327803417",
            "telephone_number": "321-362-4099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MALLORY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-30",
        "last_updated": "2023-05-30",
        "certification_date": "2023-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taha Peerzada, DMD
• Nicholas Alexander Pefkaros, M.D.
• Steven H Perelmuter, DMD
• Perez & Rivera P L
• Peter E. Balsam, MD, Facg
• Michael Pfeiffer, D.P.T.
• David Merrill Phillips, R.PH
• Monell Phillips
• Noelle Phillips, PT
• Paul James Pierce, PTA

• Speech-Language Pathologist in Titusville, FL
• Providers in Titusville, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2023; 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.