Active NPI
Lisa Peterson
- Speech-Language Pathologist
- Center, MO
National Provider Identifier
1497154033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 0347894
- Practice address
- 407 N Foster St
Center, MO 63436-1026 - Phone
- (573) 267-3963
- NPI assigned
- Aug 20, 2014
- Last updated
- Aug 20, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 | 0347894 | MO | Primary |
Addresses
Primary practice location
407 N Foster St
Center, MO 63436-1026
Mailing address
407 N Foster St
PO Box 117
Center, MO 63436-1026
Phone (573) 267-3963
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0347894 | Other | MO | MISSOURI DEPARTMENT OF EDUCATION-TEACHING CERTIFICATE |
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 |
|---|---|---|---|
| 0347894 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408492800000",
"number": "1497154033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 N FOSTER ST",
"address_2": "PO BOX 117",
"city": "CENTER",
"state": "MO",
"postal_code": "634361026",
"telephone_number": "573-267-3963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 N FOSTER ST",
"city": "CENTER",
"state": "MO",
"postal_code": "634361026",
"telephone_number": "573-267-3963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "LISA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-20",
"last_updated": "2014-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "0347894",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSOURI DEPARTMENT OF EDUCATION-TEACHING CERTIFICATE",
"identifier": "0347894",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Center, MO
- Leah May Caputo
- Gpmo, Inc (Grand Pharmacy Ralls County)
- Hannibal Clinic Operations, L.L.C.
- Hannibal Regional Hospital
- Mma Healthcare of Center, Inc. (Westview Nursing Home)
- Preferred Family Healthcare, Inc. (Clarity Healthcare)
- Ralls County R-II School District
- Mark Alan Tucker, D.O.
- Westview SNF Opco LLC (Westview Nursing Home)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.