Kirsten E Petersen, MA, CCC-SLP, TSLD,BE

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

021322-1 Issued in NY

Practice address

40 Mulberry Ave
Garden City, NY 11530-1830

Phone

(516) 474-1766

NPI assigned

Sep 13, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor or Engineering, Master of Arts

State licenses

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

{
    "created_epoch": "1347494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347494400000",
    "number": "1326398660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 MULBERRY AVE",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115301830",
            "telephone_number": "516-474-1766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 MULBERRY AVE",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115301830",
            "telephone_number": "516-474-1766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KIRSTEN",
        "middle_name": "E",
        "name_prefix": "Miss",
        "credential": "MA, CCC-SLP, TSLD,BE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-13",
        "last_updated": "2012-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "021322-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Pesce, OTR/L
• Robert M Peskin, D.D.S.
• Chevanie Peter Cunningham
• Peter E Oneill MD PC
• Marisa Louise Peters, LMSW
• Glenn Austin Petraitis, PTA
• Nicholas Petrini, PA-C
• Lorraine Elizabeth Petrizzo, MS.ED, BCBA
• Meagan Pettit, LMHC
• Eugene P Pezzollo, D.M.D.

• Speech-Language Pathologist in Garden City, NY
• Providers in Garden City, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2012; 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.