Krista Kelly Petersen

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

8918 Issued in MN

Practice address

6200 Xerxes Ave S
Edina, MN 55423-1033

Phone

(952) 925-8500

NPI assigned

Jun 28, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: krista.petersen@westwoodcc.org

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1821668245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 FAIRWAY DR",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553363214",
            "telephone_number": "952-465-7636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 XERXES AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554231033",
            "telephone_number": "952-925-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KRISTA",
        "middle_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "8918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Krista.petersen@westwoodcc.org",
            "affiliation": "N",
            "endpointDescription": "work",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6200 Xerxes Ave S",
            "city": "Edina",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554231033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephanie Peters
• Stephanie Linnea Peters, MS, PA-C
• Allison Wichmann Petersen, PA
• Douglas George Petersen, DDS
• Juliette E Petersen, MD
• Rebecca Marie Petersen, LAC
• Victoria Peterson-Hilleque, LP
• Allison Kay Peterson, M.A., L.P.
• Amanda Ann Peterson, RD
• Daniel B Peterson, MD

• Speech-Language Pathologist in Edina, MN
• Providers in Edina, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.