Provider Demographics
NPI:1346718533
Name:PETTIT, DANNY LOUIS (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:LOUIS
Last Name:PETTIT
Suffix:
Gender:M
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 1:2026 STATE ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:AUSTINBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44010-9711
Mailing Address - Country:US
Mailing Address - Phone:440-275-3019
Mailing Address - Fax:440-275-3366
Practice Address - Street 1:2026 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:AUSTINBURG
Practice Address - State:OH
Practice Address - Zip Code:44010-9711
Practice Address - Country:US
Practice Address - Phone:440-275-3019
Practice Address - Fax:440-275-3366
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP10767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist