Active NPI
Angela Marie Petricca, M.S. CCC-SLP/L
- Speech-Language Pathologist
- Elk Grove VLG, IL
National Provider Identifier
1649448770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.011210
- Practice address
- 555 Jersey LN
Elk Grove VLG, IL 60007-2765 - Phone
- (847) 293-4787
- NPI assigned
- Feb 11, 2008
- 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 | 146.011210 | IL | Primary |
Addresses
Primary practice location
555 Jersey LN
Elk Grove VLG, IL 60007-2765
Mailing address
555 Jersey LN
Elk Grove VLG, IL 60007-2765
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 |
|---|---|---|---|
| 146.011210 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347321600000",
"number": "1649448770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 JERSEY LN",
"city": "ELK GROVE VLG",
"state": "IL",
"postal_code": "600072765"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 JERSEY LN",
"city": "ELK GROVE VLG",
"state": "IL",
"postal_code": "600072765",
"telephone_number": "847-293-4787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRICCA",
"first_name": "ANGELA",
"middle_name": "MARIE",
"credential": "M.S. CCC-SLP/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-11",
"last_updated": "2012-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.011210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove VLG, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.