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NPI Code Detail

MEDICARE: KENNA PETERY

MEDICARE: KENNA PETERY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist922226WI

General Provider Information

NPI Number : 1356270441
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNA PETERY
Provider Business Mailing Address
First Line : 20610 W NATIONAL AVE
Second Line :
City : NEW BERLIN
State : WI
Zip : 53146-4900
Country : US
Telephone Number : 262-364-8432
Fax Number :
Provider Business Practice Location Address
First Line : 3109 MOUNT PLEASANT ST
Second Line :
City : RACINE
State : WI
Zip : 53404-1511
Country : US
Telephone Number : 262-631-0998
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2026
Last Update Date : 05/28/2026

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Directions to “ KENNA PETERY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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