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Mary Alice Petersen , MA, CCC-SLP

Speech-Language Pathologist β€’ Newcastle, WY

Active NPI 1063661916 Individual Practitioner Female Practitioner
Practice location in NPPES

104 Stampede St
Newcastle, WY 827013037

Call 3077464560 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

104 Stampede St

Newcastle, WY 827013037

Telephone 3077464560
Organization at the Same NPPES Address or Phone
Weston County Children's Center Facility NPI 1003954892

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

NPI first issued

2008

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Newcastle and Wyoming

4 active clinicians are listed under Speech-Language Pathologist with a practice address in Newcastle, WY (330 in Wyoming).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

License # reported to NPPES WY #SP-391

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Wyoming State Medical Licensing Board.
Look Up on State Board Site

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

11 Historical Events
βœ…
NPI Profile Active February 15, 2017

NPI status registered as active in NPPES database

πŸ“
Updated Practice Location February 15, 2017

Registered at 104 STAMPEDE ST, NEWCASTLE, WY 827013037 (Tel: 3077464560)

πŸ“
Updated Business Mailing Address February 15, 2017

Registered at 104 STAMPEDE ST, NEWCASTLE, WY 827013037 (Tel: 3077464560)

πŸ‘€
Provider Name / Credentials Updated February 15, 2017

Recorded as MARY PETERSEN, MA, CCC-SLP

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) February 15, 2017

Speech-Language Pathologist (license number reported to NPPES: WY #SP-391)

βœ…
NPI Profile Active September 16, 2008

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) September 16, 2008

Registered at 104 STAMPEDE ST, NEWCASTLE, WY 827013037 (Tel: 3077464560)

πŸ“
Business Mailing Address (Initial Record) September 16, 2008

Registered at 104 STAMPEDE ST, NEWCASTLE, WY 827013037 (Tel: 3077464560)

πŸ‘€
Provider Name / Credentials (Initial Record) September 16, 2008

Recorded as MARY PETERSEN, MA, CCC-SLP

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) September 16, 2008

Speech-Language Pathologist (license number reported to NPPES: WY #SP-391)

🟒
Initial NPI Registration & Enumeration September 16, 2008

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1063661916
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 16, 2008
Last Update: February 15, 2017
Sole Proprietor: Yes

Mailing Address

104 Stampede St

Newcastle, WY 827013037

Phone: 3077464560

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.