Makenzie Petermann, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2019031361 Issued in MO

Practice address

825 Pearl Ave
Joplin, MO 64801-9025

Phone

(417) 625-5200

NPI assigned

Jul 24, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Royalty Speech Therapy, LLC

  • Speech-Language Pathologist
  • Miami, OK
  • NPI 1790291367
  NPD (past)

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

{
    "created_epoch": "1563926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1851945208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 PEARL AVE",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648019025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 PEARL AVE",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648019025",
            "telephone_number": "417-625-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERMANN",
        "first_name": "MAKENZIE",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-24",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "2019031361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine D Perrey, SLP
• Charria N Perry
• David Andrew Perry, PHARMD
• Mitesh Persaud
• Michael Peterman, LPC
• Kari Lynn Petersen, LMSW
• Corey Nathaniel Peterson, DPT
• Heather N Peterson, LCSW
• Heidi Jane Peterson, CRNA
• Jeannie Marie Peterson, CRNA

• Speech-Language Pathologist in Joplin, MO
• Providers in Joplin, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.