Marissa Peterson, MA/CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP-1685 Issued in ID

Practice address

545 Lincoln Dr
Idaho Falls, ID 83401-4118

Phone

(208) 757-8553

NPI assigned

Jun 23, 2008

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

Credentials

Master of Arts

State licenses

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.

• Peterson Speech Therapy

  • Speech-Language Pathologist
  • Idaho Falls, ID
  • NPI 1497188387
  NPD (past) Authorized official
• Peterson Therapy Services, Inc

  • Speech-Language Pathologist
  • Idaho Falls, ID
  • NPI 1427536614
  NPD (past) Authorized official

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247356800000",
    "number": "1669633590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2943",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834032943",
            "telephone_number": "208-757-8553",
            "fax_number": "208-524-1929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 LINCOLN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014118",
            "telephone_number": "208-757-8553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARISSA",
        "credential": "MA/CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2009-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "SLP-1685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malik Peterson, DO, DO
• Emily Peterson
• Jason M Peterson, DDS
• Jennifer Rae Peterson, LMSW
• Leon C Peterson, O.D.
• Russell Henry Peterson, M.S.
• Pettingill Counseling PC
• Pettingill Counseling Services
• Pettingill Counseling Services, PC
• Pettingill Counseling Services, Professional Corporation

• Speech-Language Pathologist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Speech-Language Pathologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2009; 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.