Active NPI
Sally Ann Peterson, MS, CCC-SLP
- Speech-Language Pathologist
- Hudson, WI
National Provider Identifier
1568568442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1768
- Practice address
- 2705 Enloe St
Hudson, WI 54016-8173 - Phone
- (715) 386-2128
- Fax
- (715) 386-6119
- NPI assigned
- Sep 16, 2006
- Last updated
- Jul 9, 2007
- 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 | 1768 | WI | Primary |
Addresses
Primary practice location
2705 Enloe St
Hudson, WI 54016-8173
Mailing address
214 Glenmont Rd
River Falls, WI 54022-8018
Phone (715) 425-8975
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15665 | Other | HEALTH PARTNERS | |
| 42626000 | Medicaid | WI | |
| 7038035 | Other | AETNA | |
| 98G68PE | Other | MN | MN BCBS |
| 4607091 | Other | MEDICA | |
| 641671046996 | Other | PREFERRED ONE |
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1768 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1568568442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "214 GLENMONT RD",
"city": "RIVER FALLS",
"state": "WI",
"postal_code": "540228018",
"telephone_number": "715-425-8975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2705 ENLOE ST",
"city": "HUDSON",
"state": "WI",
"postal_code": "540168173",
"telephone_number": "715-386-2128",
"fax_number": "715-386-6119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "SALLY",
"middle_name": "ANN",
"credential": "MS, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "1768",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "15665",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42626000",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7038035",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BCBS",
"identifier": "98G68PE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "4607091",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "641671046996",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Hudson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.