Kelly Peterson, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SL013217 Issued in PA

Practice address

81 E Dillon Dr
Titusville, PA 16354-2402

Phone

(814) 827-2727

NPI assigned

Mar 3, 2017

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1488499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488499200000",
    "number": "1982144366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8796 ROUTE 219",
            "city": "BROCKWAY",
            "state": "PA",
            "postal_code": "158246010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 E DILLON DR",
            "city": "TITUSVILLE",
            "state": "PA",
            "postal_code": "163542402",
            "telephone_number": "814-827-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KELLY",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-03",
        "last_updated": "2017-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL013217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "813221954",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renu Paneru, MD
• Jeremy Thomas Parsons
• Penn Neuromuscular Diagnostics, LLC
• Pennsylvania CVS Pharmacy, L.L.C.
• Autumn Storm Peterson
• Tammy Pfeiffer, PT
• Catherine Policarpio Policina, MD
• Cristian L Popescu, MD
• Primary Health Network
• Primary Health Network

• Speech-Language Pathologist in Titusville, PA
• Providers in Titusville, PA by specialty
• Speech-Language Pathologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; 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.