Kelly Petersen, MS CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.008489 Issued in IL

Practice address

51 W Schaumburg Rd
Schaumburg, IL 60194-3506

Phone

(815) 469-1500

NPI assigned

Apr 29, 2008

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• North Dupage Spec Ed Coop

  • Local Education Agency (LEA)
  • Roselle, IL
  • NPI 1528199635
  NPD (past)
• Westside Childrens Therapy

  • Physical Therapist
  • Joliet, IL
  • NPI 1972783900

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1487829438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 BEDFORD RD",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "601694824",
            "telephone_number": "630-709-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 W SCHAUMBURG RD",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601943506",
            "telephone_number": "815-469-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "132 E Pine Ave",
            "address_purpose": "LOCATION",
            "city": "Roselle",
            "state": "IL",
            "postal_code": "601722252",
            "country_code": "US",
            "telephone_number": "630-834-0490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KELLY",
        "credential": "MS CCC SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-29",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.008489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert F. Perry, P.T.
• Arti Persaud, LPC
• Personal Growth Associates, Inc.
• Judy R Peskind, LCPC
• Annabel Petersen
• Melissa Petersohn, O.D.
• Bruce B Peterson, O.D.
• Danielle Marie Peterson
• Gabriela Daniel Petrova
• Mark Paul Pettersen, MA LPC

• Speech-Language Pathologist in Schaumburg, IL
• Providers in Schaumburg, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.