Mary Elizabeth Petoskey, MS/CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

419-154 Issued in WI

Practice address

2900 W. Oklahoma Ave
Milwaukee, WI 53215-0000

Phone

(414) 649-7772

Fax

(414) 649-7977

NPI assigned

Mar 6, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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.

• Lakeshore Medical Clinic, LLC

  • Family Medicine Physician
  • Saint Francis, WI
  • NPI 1003861188
  Medicare reassignment Care Compare group NPD
• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378
  Medicare reassignment NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Oshkosh, WI
  • NPI 1326858044
  NPD
• Aurora Medical Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milwaukee, WI
  • NPI 1659599157
  NPD
• Lakeshore Medical Clinic LTD

  • Family Medicine Physician
  • South Milwaukee, WI
  • NPI 1174851893
  NPD
• Aurora Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Manitowoc, WI
  • NPI 1801941075
  NPD (past)
• Milwaukee Ear Nose Throat Clinic Limited

  • Facial Plastic Surgery Physician
  • Mequon, WI
  • NPI 1457497091
  NPD (past)
• Milwaukee ENT Speech & Hearing Aid Service

  • Hearing Aid Equipment
  • Mequon, WI
  • NPI 1982726659
  NPD (past)

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

{
    "created_epoch": "1330992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1265706444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10945 N. PORT WASHINGTON RD.",
            "address_2": "SUITE 211",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530920000",
            "telephone_number": "262-241-8000",
            "fax_number": "262-241-8096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 W. OKLAHOMA AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532150000",
            "telephone_number": "414-649-7772",
            "fax_number": "414-649-7977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETOSKEY",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "MS/CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-06",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "419-154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "2900 W. Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532150000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpetoskey25527@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "2900 W. Oklahoma Ave",
            "city": "Milwaukee",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532150000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Peterson, DO
• Samuel Peterson
• Stacy Peterson, M.D.
• Steven Peterson, MD
• Tammy Peterson, PTA
• Holly Petrauskas, LPC, CSAC, NCC
• Sara K.G. Petre, NP
• Travis Graham Petricek, MD
• Amanda Petrie, PHARMD
• Timothy Petrie, DPT

• Speech-Language Pathologist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; 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.