Provider Demographics
NPI:1891434254
Name:PETIT, EMILY ELIZABETH (MS, SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:PETIT
Suffix:
Gender:F
Credentials:MS, SLP
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 354
Mailing Address - Street 2:
Mailing Address - City:PAULINA
Mailing Address - State:LA
Mailing Address - Zip Code:70763-0354
Mailing Address - Country:US
Mailing Address - Phone:225-331-1414
Mailing Address - Fax:
Practice Address - Street 1:1959 LA-3125
Practice Address - Street 2:SUITE 3
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-2528
Practice Address - Country:US
Practice Address - Phone:225-331-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9000OtherSPEECH LANGUAGE PATHOLOGIST