Active NPI
Jody Petersen
- Speech-Language Pathologist
- Charlestown, MA
National Provider Identifier
1598026080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SL010621
- Practice address
- 21 Sackville St Unit a
Charlestown, MA 02129-2041 - Phone
- (856) 889-7310
- NPI assigned
- May 31, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 | SL010621 | PA | Primary |
Addresses
Primary practice location
21 Sackville St Unit a
Charlestown, MA 02129-2041
Mailing address
21 Sackville St Unit a
Charlestown, MA 02129-2041
Phone (856) 889-7310
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SL010621 | PA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597881600000",
"number": "1598026080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 SACKVILLE ST UNIT A",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021292041",
"telephone_number": "856-889-7310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 SACKVILLE ST UNIT A",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021292041",
"telephone_number": "856-889-7310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "JODY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-31",
"last_updated": "2020-08-20",
"certification_date": "2020-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL010621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlestown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.