Provider Demographics
NPI:1295998623
Name:PELLETIER, CATHY A (PHD, MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:PHD, MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 SAMPLES RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-1656
Mailing Address - Country:US
Mailing Address - Phone:607-279-3342
Mailing Address - Fax:
Practice Address - Street 1:7516 SAMPLES RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-1656
Practice Address - Country:US
Practice Address - Phone:607-279-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist