Active NPI
Penny Petrik, ED.S.
- School Psychologist
- Madison, SD
National Provider Identifier
1265985774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 63594-2
- Practice address
- 820 N Washington Ave
Heartland Building
Madison, SD 57042-1735 - Phone
- (605) 256-5555
- NPI assigned
- Aug 2, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 63594-2 | SD | Primary |
Addresses
Primary practice location
820 N Washington Ave
Heartland Building
Madison, SD 57042-1735
Mailing address
820 N Washington Ave
Heartland Building
Madison, SD 57042-1735
Phone (605) 256-5555
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 |
|---|---|---|---|
| 63594-2 | SD | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470096000000",
"number": "1265985774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 N WASHINGTON AVE",
"address_2": "HEARTLAND BUILDING",
"city": "MADISON",
"state": "SD",
"postal_code": "570421735",
"telephone_number": "605-256-5555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 N WASHINGTON AVE",
"address_2": "HEARTLAND BUILDING",
"city": "MADISON",
"state": "SD",
"postal_code": "570421735",
"telephone_number": "605-256-5555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRIK",
"first_name": "PENNY",
"credential": "ED.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-02",
"last_updated": "2016-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "SD",
"license": "63594-2",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.