Kacie Webb Peterson, MA, CCC-L/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

7374 Issued in LA

Practice address

852 University Dr
Lake Charles, LA 70605-6120

Phone

(337) 419-0086

Fax

(337) 415-0626

NPI assigned

Jun 24, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Magnolia Pediatric Therapy, LLC

  • Speech-Language Pathologist
  • Lake Charles, LA
  • NPI 1346690740
  NPD (past)

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521590400000",
    "number": "1598147753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3990 N BLUE SAGE RD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706050189",
            "telephone_number": "337-802-0473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "852 UNIVERSITY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706056120",
            "telephone_number": "337-419-0086",
            "fax_number": "337-415-0626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KACIE",
        "middle_name": "WEBB",
        "credential": "MA, CCC-L/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-24",
        "last_updated": "2018-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "7374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2450662",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Pesic, M.A., LPC
• Pet Imaging of Southwest Louisiana, LLC
• Alfred H Pete
• Jessica Pete, PHARM.D.
• Kristie Pete, RN
• Linda R Peterson, OT
• Rebecca Caroline Pettefer, PLPC
• Christe Hester Pettis, M.A., CCC-SLP
• Michael Rand Pettit, PHARMD
• Robin P Pettit, PHARMD

• Speech-Language Pathologist in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Speech-Language Pathologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; 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.