Active NPI
Sandra Lee Petrie, M.A. CCC/SLP
- Speech-Language Pathologist
- Oswego, IL
National Provider Identifier
1891930202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146.009643
- Practice address
- 662 Manhattan Cir
Oswego, IL 60543-9805 - Phone
- (630) 740-1112
- NPI assigned
- Dec 14, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146.009643 | IL | Primary |
Addresses
Primary practice location
662 Manhattan Cir
Oswego, IL 60543-9805
Mailing address
662 Manhattan Cir
Oswego, IL 60543-9805
Phone (630) 740-1112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146.009643 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229212800000",
"number": "1891930202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "662 MANHATTAN CIR",
"city": "OSWEGO",
"state": "IL",
"postal_code": "605439805",
"telephone_number": "630-740-1112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "662 MANHATTAN CIR",
"city": "OSWEGO",
"state": "IL",
"postal_code": "605439805",
"telephone_number": "630-740-1112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRIE",
"first_name": "SANDRA",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "M.A. CCC/SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-14",
"last_updated": "2008-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146.009643",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oswego, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.