Active NPI
Adrienne Peterson, MS, CCC-SLP
- Speech-Language Pathologist
- Mill Creek, WA
National Provider Identifier
1730221391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- LL60320131
- Practice address
- 13302 47TH Ave SE
Mill Creek, WA 98012-8970 - Phone
- (509) 720-7842
- NPI assigned
- Feb 12, 2007
- 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 | LL60320131 | WA | Primary |
Addresses
Primary practice location
13302 47TH Ave SE
Mill Creek, WA 98012-8970
Mailing address
13302 47TH Ave SE
Mill Creek, WA 98012-8970
Phone (509) 720-7842
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010155758 | Other | ID | BLUE SHIELD PROVIDER NUMB |
| SPL02 | Other | ID | BLUE CROSS PROVIDER NUMBE |
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 |
|---|---|---|---|
| LL60320131 | WA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447718400000",
"number": "1730221391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13302 47TH AVE SE",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "980128970",
"telephone_number": "509-720-7842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13302 47TH AVE SE",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "980128970",
"telephone_number": "509-720-7842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "ADRIENNE",
"credential": "MS, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-12",
"last_updated": "2015-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "LL60320131",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PROVIDER NUMB",
"identifier": "000010155758",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER NUMBE",
"identifier": "SPL02",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mill Creek, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.