Jennifer L Petersen, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

020216-1 Issued in NY

Practice address

53 Bedford Ave
Middletown, NY 10940-6414

Phone

(845) 326-1784

NPI assigned

Mar 1, 2011

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1298937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298937600000",
    "number": "1558669523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 255",
            "city": "SUMMITVILLE",
            "state": "NY",
            "postal_code": "127810255",
            "telephone_number": "845-888-5411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 BEDFORD AVE",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109406414",
            "telephone_number": "845-326-1784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-01",
        "last_updated": "2011-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "020216-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louis George Petcu, M.D.
• Jennifer Peterman
• Susan Peters Manez, MSRD
• Marian Peters
• Scott C Peters, D.M.D.
• Pamela H Petersen, CNM
• Amanda Joy Peterson
• Travonna Peterson, FNP-BC
• Katherine A. Petrillo, R.N.
• Christine Pettit, APRN

• Speech-Language Pathologist in Middletown, NY
• Providers in Middletown, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; 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.