Basic Information
| Provider Information | |||||||||
| NPI: | 1316242829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETTIT | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | MOORE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | SPEECH THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23996 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392253996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012066100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 PARKWAY PLZ | ||||||||
| Address2: | |||||||||
| City: | KOSCIUSKO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390903217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622893588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2011 | ||||||||
| LastUpdateDate: | 04/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | S3248 | MS | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.