Active NPI
Diane Peterson, MS, CCC/SLP
- Speech-Language Pathologist
- Waco, TX
National Provider Identifier
1538670278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 14770
- Practice address
- 900 Washington Ave Ste 602
Waco, TX 76701-1283 - Phone
- (254) 296-9792
- NPI assigned
- Oct 20, 2017
- 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 | 14770 | TX | Primary |
Addresses
Primary practice location
900 Washington Ave Ste 602
Waco, TX 76701-1283
Mailing address
900 Washington Ave Ste 602
Waco, TX 76701-1283
Phone (254) 296-9792
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14770 | TX | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tots in Tow, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508457600000",
"number": "1538670278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 WASHINGTON AVE STE 602",
"city": "WACO",
"state": "TX",
"postal_code": "767011283",
"telephone_number": "254-296-9792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 WASHINGTON AVE STE 602",
"city": "WACO",
"state": "TX",
"postal_code": "767011283",
"telephone_number": "254-296-9792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DIANE",
"credential": "MS, CCC/SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-20",
"last_updated": "2017-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "14770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.