Lauren Petruska

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

2450 44TH St SE Ste 201
Grand Rapids, MI 49512-9081

Phone

(616) 325-4839

NPI assigned

Oct 28, 2024

Sex

Female

Sole proprietor

No

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

Enrolled in MI

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Duncan Lake Speech Therapy, LLC

  • Speech-Language Pathologist
  • Kentwood, MI
  • NPI 1376195925
  Medicare reassignment NPD

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

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1124840616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 44TH ST SE STE 201",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495129081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 44TH ST SE STE 201",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495129081",
            "telephone_number": "616-325-4839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUSKA",
        "first_name": "LAUREN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Bradford Petrous, DO
• Steven Peter Petrovas, M.D.
• Amanda Petrovich
• Jerry Alvin Petrovich, MSW
• Breanna Marie Petrucciani, MS, RDN
• Susanne Pettigrew, PA-C
• Erin Megan Pettijohn, M.D.
• Stuart Pettijohn, DDS
• Jayne Deur Pettinga, NURSE PRACTITIONER
• Matthew Scott Pettinga, MA, LPC

• Speech-Language Pathologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Speech-Language Pathologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.