Provider Demographics
NPI:1316242829
Name:PETTIT, WHITNEY MOORE (SPEECH THERAPIST)
Entity type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:MOORE
Last Name:PETTIT
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
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 23996
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3996
Mailing Address - Country:US
Mailing Address - Phone:601-206-6100
Mailing Address - Fax:
Practice Address - Street 1:130 PARKWAY PLZ
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3217
Practice Address - Country:US
Practice Address - Phone:662-289-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist