Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Mary Elizabeth Petoskey, MS/CCC-SLP

Individual provider Speech-Language Pathologist · NPI 1265706444

Mrs. Mary Elizabeth Petoskey, MS/CCC-SLP is a Qualified Speech Language Pathologist in Milwaukee, Wisconsin. Qualified in 1990, 36 years ago. Practices with Lakeshore Medical Clinic LLC, a 379-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
36
Licensed in
WI
In the registry since
2012
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Practice location Address checks out

2900 W Oklahoma Ave
Milwaukee, WI 53215-0000
Phone: (414) 649-7772
Fax: (414) 649-7977
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 419-154 (WI)

Record details

NPI number1265706444
Entity typeIndividual (Type 1)
GenderFemale
Credentials MS/CCC-SLP
Sole proprietorYes
NPI enumeratedMarch 6, 2012
Last updated in NPPESDecember 13, 2021
Certification dateDecember 13, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyQUALIFIED SPEECH LANGUAGE PATHOLOGIST
Medical schoolOTHER
Graduated 1990 (36 years in practice)
Group practice Lakeshore Medical Clinic Llc — 379 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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