Provider Demographics
NPI:1124305339
Name:PELLETIER, CHRISTOPHER D
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:D
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:557 MAIN STREET
Mailing Address - City:RALSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82440-0721
Mailing Address - Country:US
Mailing Address - Phone:307-754-3464
Mailing Address - Fax:307-754-3464
Practice Address - Street 1:557 MAIN STREET
Practice Address - Street 2:BOX 721
Practice Address - City:RALSTON
Practice Address - State:WY
Practice Address - Zip Code:82440-0721
Practice Address - Country:US
Practice Address - Phone:307-754-3464
Practice Address - Fax:307-754-3464
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY163237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist