Pediatric Rehabilitation Northwest

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

PEDIATRIC REHABILITATION NORTHWEST

Doing business as

PRNW

Practice address

655 Mule Deer St NW
Salem, OR 97304-3678

Phone

(209) 769-2039

NPI assigned

Dec 1, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyle Davey

Title

Ceo

Phone

(209) 769-2039

Specialties & licenses 2

Addresses

Other names 1

• PRNW Doing business as

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

{
    "created_epoch": "1669852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1982314951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 MULE DEER ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973043678",
            "telephone_number": "209-769-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 MULE DEER ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973043678",
            "telephone_number": "209-769-2039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC REHABILITATION NORTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-01",
        "last_updated": "2022-12-01",
        "certification_date": "2022-11-30",
        "status": "A",
        "authorized_official_last_name": "DAVEY",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-769-2039"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRNW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steven Michael Peck, DMD
• Niels Frederik Pedersen, MD
• Gary Theodore Pederson, D.D.S.
• Pediatric Dental Associates of Salem
• Pediatric Dentistry of Salem LLC
• Peers for Love, Inc.
• Richard Peffley II, D.P.M.
• Zheng Sheng Peh, PHARMD
• Krystyna Antonina Pekalska, M.D.
• Mireya Pelayo Brambila

• Speech-Language Pathologist in Salem, OR
• Providers in Salem, OR by specialty
• Speech-Language Pathologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; 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.