Lynda Lee Peterson, MA-CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6329 Issued in MN

Practice address

1891 Station Pkwy NW
Andover, MN 55304-3341

Phone

(763) 755-4275

Fax

(763) 755-4261

NPI assigned

Oct 31, 2006

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 names 1

• Linda Gayle Peterson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551139200000",
    "number": "1376629360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9912-300TH AVE. N.",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "55371",
            "telephone_number": "763-389-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 STATION PKWY NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043341",
            "telephone_number": "763-755-4275",
            "fax_number": "763-755-4261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LYNDA",
        "middle_name": "LEE",
        "credential": "MA-CCC/SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2019-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "6329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LINDA",
            "last_name": "PETERSON",
            "middle_name": "GAYLE",
            "credential": "MA-CCC/SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Andover, MN
• Providers in Andover, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; 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.