Active NPI
Lynn T Peterson, CCC-SLP
- Speech-Language Pathologist
- Tacoma, WA
National Provider Identifier
1114090743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- LL00002747
- Practice address
- 1310 S Union Ave Ste A100
Tacoma, WA 98405-1907 - Phone
- (253) 383-2423
- NPI assigned
- Nov 15, 2006
- Sex
- Female
- Sole proprietor
- No
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 | LL00002747 | WA | Primary |
Addresses
Primary practice location
1310 S Union Ave Ste A100
Tacoma, WA 98405-1907
Mailing address
3312 N 19TH St
Tacoma, WA 98406-6007
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7098080 | Medicaid | WA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL00002747 | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1114090743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3312 N 19TH ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984066007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1310 S UNION AVE STE A100",
"city": "TACOMA",
"state": "WA",
"postal_code": "984051907",
"telephone_number": "253-383-2423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "LYNN",
"middle_name": "T",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "LL00002747",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7098080",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.