Carolyn Peterson, MA-CCC,SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

746 Issued in MT

Practice address

239 Grannys Garden Rd
Libby, MT 59923-9218

Phone

(406) 293-7480

NPI assigned

Oct 24, 2014

Last updated

Oct 24, 2014By 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

State licenses

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

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414108800000",
    "number": "1215332846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 GRANNYS GARDEN RD",
            "city": "LIBBY",
            "state": "MT",
            "postal_code": "599239218",
            "telephone_number": "406-293-7480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 GRANNYS GARDEN RD",
            "city": "LIBBY",
            "state": "MT",
            "postal_code": "599239218",
            "telephone_number": "406-293-7480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CAROLYN",
        "credential": "MA-CCC,SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-24",
        "last_updated": "2014-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MT",
            "license": "746",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "9140",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Libby, MT
• Providers in Libby, MT by specialty
• Speech-Language Pathologist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; 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.