Active NPI
Ericka Zetterberg
- Respiratory/Developmental/Rehabilitative Specialist/Technologist
- Peoria, IL
National Provider Identifier
1992194773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Respiratory/Developmental/Rehabilitative Specialist/Technologist
- License
- 146008374
- Practice address
- 3202 N Wisconsin Ave
Peoria, IL 61603-1260 - Phone
- (309) 672-6512
- Fax
- (309) 282-3080
- NPI assigned
- Jan 15, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146008374 | IL | |
| Respiratory/Developmental/Rehabilitative Specialist/Technologist | 225500000X | 146008374 | IL | Primary |
Addresses
Primary practice location
3202 N Wisconsin Ave
Peoria, IL 61603-1260
Mailing address
2810 Frank Scott Pkwy W
Suite 824
Belleville, IL 62223-5007
Other practice location 1
2988 Court St
Pekin, IL 61554-6229
Phone (618) 234-9705
Other names 1
- Ericka Doan
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 |
|---|---|---|---|
| 146008374 | IL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Therapy Services, Inc | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Pekin, IL
- NPI 1578615225
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691020800000",
"number": "1992194773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2810 FRANK SCOTT PKWY W",
"address_2": "SUITE 824",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622235007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3202 N WISCONSIN AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616031260",
"telephone_number": "309-672-6512",
"fax_number": "309-282-3080"
}
],
"practiceLocations": [
{
"address_1": "2988 Court St",
"address_purpose": "LOCATION",
"city": "Pekin",
"state": "IL",
"postal_code": "615546229",
"country_code": "US",
"telephone_number": "618-234-9705",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ZETTERBERG",
"first_name": "ERICKA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-15",
"last_updated": "2023-08-03",
"certification_date": "2023-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146008374",
"primary": false
},
{
"code": "225500000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist",
"state": "IL",
"license": "146008374",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ERICKA",
"last_name": "DOAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.