Provider Demographics
NPI:1790516979
Name:PETRAITIS, OLIVER (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:PETRAITIS
Suffix:
Gender:M
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 WILKES LN
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-2202
Mailing Address - Country:US
Mailing Address - Phone:971-204-1909
Mailing Address - Fax:
Practice Address - Street 1:330 MADISON AVE S STE 106
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE IS
Practice Address - State:WA
Practice Address - Zip Code:98110-2544
Practice Address - Country:US
Practice Address - Phone:206-451-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist