Provider Demographics
NPI:1124254578
Name:PETTIS, CHRISTE HESTER (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTE
Middle Name:HESTER
Last Name:PETTIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WILLIAMSBURG ST BLDG E
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5719
Mailing Address - Country:US
Mailing Address - Phone:337-376-0136
Mailing Address - Fax:
Practice Address - Street 1:2016 EVELYN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6548
Practice Address - Country:US
Practice Address - Phone:337-433-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist