Active NPI
Kelly Lynn Deakins, MS, CCC-SLP
- Speech-Language Pathologist
- South Bend, IN
National Provider Identifier
1942791280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 22007224A
- Practice address
- 17390 Dugdale Dr
South Bend, IN 46635-1512 - Phone
- (574) 400-2169
- Fax
- (317) 520-8200
- NPI assigned
- May 22, 2018
- Last updated
- Jul 18, 2019
- Sex
- Female
- Sole proprietor
- No
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 | 22007224A | IN | Primary |
Addresses
Primary practice location
17390 Dugdale Dr
South Bend, IN 46635-1512
Mailing address
3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135
Phone (855) 324-0885
Other names 1
- Kelly Lynn Peterson
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22007224A | IN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| O.T. Works, Inc | Past | Accepting new patients | |
| O.T. Works, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Occupational Therapist
- Nappanee, IN
- NPI 1558512079
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563408000000",
"number": "1942791280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 DEPAUW BLVD STE 3070",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462686135",
"telephone_number": "855-324-0885",
"fax_number": "317-520-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17390 DUGDALE DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351512",
"telephone_number": "574-400-2169",
"fax_number": "317-520-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEAKINS",
"first_name": "KELLY",
"middle_name": "LYNN",
"credential": "MS, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-22",
"last_updated": "2019-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IN",
"license": "22007224A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "PETERSON",
"middle_name": "LYNN",
"credential": "MS, CF-SLP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.