Individual provider Active NPI

Riley Rachelle Pettijohn, MS, CCC-SLP

  • Speech-Language Pathologist
  • Bethany, OK
National Provider Identifier
1245809292
Registry record updated Oct 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
5704 Issued in OK
Practice address
6800 NW 39TH Expy
Bethany, OK 73008-2513
Phone
(405) 789-6711
Fax
(405) 438-3834
NPI assigned
Jun 23, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X CF350 OK
Speech-Language Pathologist 235Z00000X 5704 OK Primary

Addresses

Primary practice location

6800 NW 39TH Expy
Bethany, OK 73008-2513

Mailing address

6800 NW 39TH Expy
Bethany, OK 73008-2513
Phone (405) 789-6711

Other practice location 1

1824 Commons Cir Ste B
Yukon, OK 73099-9538
Phone (405) 467-6782

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
5704OKMDOccupational Therapist
CF350OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Complete Rehab, LLC Speech-Language Pathologist CurrentSince Feb 1, 2022 Accepting new patients
The Children'S Center Past Accepting new patients

Locations

1824 Commons Cir
Ste B
Yukon, OK 73099
Phone (405) 324-0961

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761609600000",
    "number": "1245809292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 NW 39TH EXPY",
            "city": "BETHANY",
            "state": "OK",
            "postal_code": "730082513",
            "telephone_number": "405-789-6711",
            "fax_number": "405-438-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 NW 39TH EXPY",
            "city": "BETHANY",
            "state": "OK",
            "postal_code": "730082513",
            "telephone_number": "405-789-6711",
            "fax_number": "405-438-3834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1824 Commons Cir Ste B",
            "address_purpose": "LOCATION",
            "city": "Yukon",
            "state": "OK",
            "postal_code": "730999538",
            "country_code": "US",
            "telephone_number": "405-467-6782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTIJOHN",
        "first_name": "RILEY",
        "middle_name": "RACHELLE",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-23",
        "last_updated": "2025-10-28",
        "certification_date": "2025-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "CF350",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "5704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethany, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2025; 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.