Active NPI
Amber Petereck
- Speech-Language Pathologist
- Eagan, MN
National Provider Identifier
1457893307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 9508
- Practice address
- 2030 Rahn Way
Eagan, MN 55122-2300 - Phone
- (651) 529-1966
- NPI assigned
- Nov 9, 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 9508 | MN | Primary |
Addresses
Primary practice location
2030 Rahn Way
Eagan, MN 55122-2300
Mailing address
2030 Rahn Way
Eagan, MN 55122-2300
Phone (651) 529-1966
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 |
|---|---|---|---|
| 9508 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fraser Child and Family Center | Past | Accepting new patients | |
| Fraser | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rehabilitation Clinic/Center
- Richfield, MN
- NPI 1063568574
-
- Adolescent and Children Mental Health Clinic/Center
- Minneapolis, MN
- NPI 1609922194
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478649600000",
"number": "1457893307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2030 RAHN WAY",
"city": "EAGAN",
"state": "MN",
"postal_code": "551222300",
"telephone_number": "651-529-1966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 RAHN WAY",
"city": "EAGAN",
"state": "MN",
"postal_code": "551222300",
"telephone_number": "651-529-1966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERECK",
"first_name": "AMBER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-09",
"last_updated": "2016-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "9508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.