Peterson Speech Therapy

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

PETERSON SPEECH THERAPY

Practice address

545 Lincoln Dr
Idaho Falls, ID 83401-4118

Phone

(208) 757-8553

NPI assigned

Aug 14, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Marissa Lynne Peterson, MA/CCC-SLPNPI 1669633590

Title

Speech Language Pathologist

Phone

(208) 757-8553

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marissa Peterson, MA/CCC-SLP

  • Speech-Language Pathologist
  • Idaho Falls, ID
  • NPI 1669633590
  NPD (past) Authorized official

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

{
    "created_epoch": "1376438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376438400000",
    "number": "1497188387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 LINCOLN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014118",
            "telephone_number": "208-757-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 LINCOLN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014118",
            "telephone_number": "208-757-8553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON SPEECH THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-14",
        "last_updated": "2013-08-14",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "208-757-8553",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA/CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kiley Petencin
• Iris Peter, PA-C
• Ryne Shawn Peters, DO
• Betsy Pack Petersen, LMSW
• Emily Petersen
• Peterson Therapy Services, Inc
• Chase Peterson, DPT
• Chelsea Joan Peterson, MOTR/L
• Corene Peterson, LCSW
• Malik Peterson, DO, DO

• Speech-Language Pathologist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Speech-Language Pathologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; 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.