Kallie Peterson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

14336560 Issued in CO

Practice address

9751 Regent Ave N
Brooklyn Park, MN 55443-1402

Phone

(763) 315-5340

NPI assigned

Jul 21, 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

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ascend Rehab, LLC

  • Physical Therapy Clinic/Center
  • St Louis Park, MN
  • NPI 1437403110
  Medicare reassignment NPD
• Saint Therese of Oxbow Lake, LLC

  • Skilled Nursing Facility
  • Brooklyn Park, MN
  • NPI 1619236767
  NPD (past)

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1891368395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 HIGHWAY 100 S STE 103",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554161599",
            "telephone_number": "763-531-5039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9751 REGENT AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431402",
            "telephone_number": "763-315-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KALLIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-21",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "CO",
            "license": "14336560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "PointClickCare",
            "affiliation": "Y",
            "affiliationName": "St. Paul Health Center, LTD",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1667 Saint Paul St",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802061614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Peaceful Living Professionals, LLC
• Ravaughn Perry
• Nadya C Persaud, LICSW
• Personality Eyewear
• Amy Peterson, RN, BSN, PHN
• Kathleen T Pfaff, CNM
• Piso Health Care Services LLC (N/a)
• Planned Parenthood Minnesota, North Dakota, South Dakota
• Plateau Healthcare Laramie LLC (PHC Laramie)
• Plateau Healthcare Mount Curve I LLC (PHC Mount Curve)

• Speech-Language Pathologist in Brooklyn Park, MN
• Providers in Brooklyn Park, 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 Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.