Shelby Michelle Petersen, SLP-A

Primary specialty

Speech-Language AssistantTaxonomy code 2355S0801X

License

18-007 Issued in AR

Practice address

10310 W Markham St Ste 205
Little Rock, AR 72205-1579

Phone

(501) 406-7910

NPI assigned

Nov 1, 2017

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

Other identifiers 1

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": "1509494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1285146142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CALAIS CV",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722239575",
            "telephone_number": "501-940-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10310 W MARKHAM ST STE 205",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722051579",
            "telephone_number": "501-406-7910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 Calais Cv",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722239575",
            "country_code": "US",
            "telephone_number": "501-940-2335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "SHELBY",
        "middle_name": "MICHELLE",
        "name_prefix": "Miss",
        "credential": "SLP-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-01",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "AR",
            "license": "18-007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS BOARD OF EXAMINERS IN SPEECH PATHOLOGY AND AUDIOLOGY",
            "identifier": "18-007",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chase Petersen, PHARM. D.
• Danielle Petersen, AU.D., CCC-A
• Erika Anne Petersen, MD
• Hannah Melissa Petersen, M.S., CCC-SLP
• Linda Louise Petersen, MS,CCC-SLP
• Brittany Peterson, APRN-CNP
• English Peterson
• Jonathan Peterson
• Montez Peterson
• Rondell Banks Peterson, M.D.

• Speech-Language Assistant in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Speech-Language Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.