Jamie Lynn Petersen

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP10183 Issued in AZ

Practice address

1400 S Dobson Rd
Mesa, AZ 85202-4707

Phone

(480) 412-7724

NPI assigned

Apr 3, 2019

Last updated

Apr 3, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in AZ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations (25 of 48)

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• BHSM Rehabilitation, LLC

  dba Banner Physical Therapy

  • Physical Therapy Clinic/Center
  • Buckeye, AZ
  • NPI 1467129684
  Medicare reassignment
• BHSM Rehabilitation LLC

  • Physical Therapy Clinic/Center
  • Casa Grande, AZ
  • NPI 1679098628
  NPD
• BHSM Rehabilitation, LLC

  dba Banner Physical Therapy

  • Physical Therapy Clinic/Center
  • Bullhead City, AZ
  • NPI 1093681033
  NPD
• BHSM Rehabilitation, LLC

  dba Banner Physical Therapy

  • Physical Therapy Clinic/Center
  • Gilbert, AZ
  • NPI 1497271431
  NPD
• BHSM Rehabilitation, LLC

  • Physical Therapy Clinic/Center
  • Glendale, AZ
  • NPI 1235654237
  NPD (past)
• BHSM Rehabilitation, LLC

  dba Banner Physical Therapy and Rehabilitation

  • Physical Therapy Clinic/Center
  • Peoria, AZ
  • NPI 1285271684
  NPD (past)

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554249600000",
    "number": "1407318819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S DOBSON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S DOBSON RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852024707",
            "telephone_number": "480-412-7724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JAMIE",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-03",
        "last_updated": "2019-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP10183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett Petersen, LMSW
• Brittney Marie Petersen, PA-C
• Courtney J Petersen
• Gary L Petersen, MD
• James Petersen, PHARMD
• Scott Petersen, DBH, LMFT, LISAC
• Amelia Peterson
• Beatrice J Peterson, DNP, PMHNP-BC
• Brian R. Peterson, D.D.S.
• Calli Tansa Peterson

• Speech-Language Pathologist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Speech-Language Pathologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.