Active NPI
Melissa Petersson
- Speech-Language Pathologist
- Conshohocken, PA
National Provider Identifier
1720386766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SL010141
- Practice address
- 625 W Ridge Pike
Building C Suite 105
Conshohocken, PA 19428-1180 - Phone
- (610) 834-4099
- NPI assigned
- Feb 28, 2011
- Last updated
- Feb 28, 2011
- 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 | SL010141 | PA | Primary |
Addresses
Primary practice location
625 W Ridge Pike
Building C Suite 105
Conshohocken, PA 19428-1180
Mailing address
1008 Pine St
Philadelphia, PA 19107-6007
Phone (201) 410-7897
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 |
|---|---|---|---|
| SL010141 | PA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Speech Pathology Consultants, Inc | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Speech-Language Pathologist
- Conshohocken, PA
- NPI 1952349375
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298851200000",
"number": "1720386766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1008 PINE ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191076007",
"telephone_number": "201-410-7897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 W RIDGE PIKE",
"address_2": "BUILDING C SUITE 105",
"city": "CONSHOHOCKEN",
"state": "PA",
"postal_code": "194281180",
"telephone_number": "610-834-4099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSSON",
"first_name": "MELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-28",
"last_updated": "2011-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "PA",
"license": "SL010141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conshohocken, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.