Provider Demographics
NPI:1568906295
Name:PETTINGILL, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:PETTINGILL
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 1:13416 79TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329-9200
Mailing Address - Country:US
Mailing Address - Phone:253-312-5672
Mailing Address - Fax:
Practice Address - Street 1:13416 79TH AVENUE CT NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98329-9200
Practice Address - Country:US
Practice Address - Phone:253-312-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10920235Z00000X
CA28065235Z00000X
WASLP.LL.60731420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist