Active NPI
Melissa Peterson
- Speech-Language Pathologist
- Elgin, IL
National Provider Identifier
1194243774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 242.004650
- Practice address
- 799 S McLean Blvd
Elgin, IL 60123-6702 - Phone
- (847) 742-3264
- NPI assigned
- Sep 5, 2017
- 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 | 242.004650 | IL | Primary |
Addresses
Primary practice location
799 S McLean Blvd
Elgin, IL 60123-6702
Mailing address
806 Woodbine Cir
Lake Zurich, IL 60047-3026
Phone (773) 558-2657
Other practice location 1
806 Woodbine Circle
Lake Zurich, IL 60047
Phone (773) 558-2657
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 |
|---|---|---|---|
| 242.004650 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1194243774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "806 WOODBINE CIR",
"city": "LAKE ZURICH",
"state": "IL",
"postal_code": "600473026",
"telephone_number": "773-558-2657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "799 S MCLEAN BLVD",
"city": "ELGIN",
"state": "IL",
"postal_code": "601236702",
"telephone_number": "847-742-3264"
}
],
"practiceLocations": [
{
"address_1": "806 Woodbine Circle",
"address_purpose": "LOCATION",
"city": "Lake Zurich",
"state": "IL",
"postal_code": "60047",
"country_code": "US",
"telephone_number": "773-558-2657",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSON",
"first_name": "MELISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-05",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "242.004650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elgin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.