Makenzie Pettit

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

304 Goldenrod Rd
Bloomington, IL 61704-7276

Phone

(309) 573-5394

Fax

(309) 324-7003

NPI assigned

Apr 24, 2019

Last updated

Aug 14, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Midwest Children's Therapy, PLLC

  • Physical Therapist
  • East Peoria, IL
  • NPI 1881466738

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1556064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1730743899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 GOLDENROD RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047276",
            "telephone_number": "309-573-5394",
            "fax_number": "309-324-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 GOLDENROD RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047276",
            "telephone_number": "309-573-5394",
            "fax_number": "309-324-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "MAKENZIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-24",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Mathew Peterson, DDS, MS
• Cade A Petrie
• Nikola Petrovic, DMD
• Kelly Petrovics
• Maegan Lavern Pettit
• Mia Pfafman
• Karen S. Pfost, PH.D.
• Rachel Lynn Phillips
• Shu Sheng Phung, OD
• Harold Frank Piccinelli, M.S., L.C.P.C.

• Speech-Language Pathologist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.