Kaylee Jo Petersen

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

902 N Church St
Gibson City, IL 60936-1075

Phone

(217) 784-4278

NPI assigned

Sep 2, 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

Other names 1

• Kaylee Jo Genzel Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1851069090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N CHURCH ST",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 N CHURCH ST",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361075",
            "telephone_number": "217-784-4278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KAYLEE",
        "middle_name": "JO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-02",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kayleepetersen",
            "affiliation": "N",
            "address_1": "902 N Church St",
            "city": "Gibson City",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609361075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KAYLEE",
            "last_name": "GENZEL",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Monica O'Neill, LCSW
• Melissa Kay Parks, RN
• Amanda Parrish, AGACNP
• Kerrie Ann Patrick, RN
• Adam Paul Pena, MD
• Phillips Warner Investments, LLC - Gibson City Operations Series
• Robert A Poole
• Ginny E Pulley, LPN
• R.a. Physical Therapy, PC
• Subbiah Rajaguru, M.D.

• Speech-Language Pathologist in Gibson City, IL
• Providers in Gibson City, 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 Sep 2, 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.