Provider Demographics
NPI:1114268992
Name:PELLETIER, KRISTI DIANE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:DIANE
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:DIANE
Other - Last Name:TRIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2203 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4412
Mailing Address - Country:US
Mailing Address - Phone:210-614-3911
Mailing Address - Fax:210-625-3162
Practice Address - Street 1:2203 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4412
Practice Address - Country:US
Practice Address - Phone:210-614-3911
Practice Address - Fax:210-625-3162
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist