Emily Elizabeth Petrucci, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

30001665 Issued in NC

Practice address

1289 Oliver St
Fayetteville, NC 28304-4450

Phone

(410) 553-2200

NPI assigned

Jul 26, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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.

• Pediatric Developmental Therapy

  • Rehabilitation Practitioner
  • Fayetteville, NC
  • NPI 1710183991
  NPD (past)
• Pediatric Developmental Therapy

  • Speech-Language Pathologist
  • Fayetteville, NC
  • NPI 1730137779
  NPD (past)

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1518630680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 87294",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283047294",
            "telephone_number": "910-483-8331",
            "fax_number": "910-483-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1289 OLIVER ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044450",
            "telephone_number": "410-553-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUCCI",
        "first_name": "EMILY",
        "middle_name": "ELIZABETH",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-26",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "30001665",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "09849",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth B Peterson, PT
• Karen Vonzeal Peterson, LCSWA
• Trinity Shatia Peterson
• Ayanah Petrie
• Kevin James Petro, LPC
• Rocco Petruolo, R N
• Audrey Petteruti, DO
• Josie Lynn Pettipiece, MS, CCC-SLP
• Natifa Pettus, LCSW
• Angela D Petty, LMFT

• Speech-Language Pathologist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.