Provider Demographics
NPI:1912231622
Name:PETRONELLA, CELESTE STYCZYNSKI (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:STYCZYNSKI
Last Name:PETRONELLA
Suffix:
Gender:F
Credentials: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 1:6246 E PIMA ST STE 14
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3157
Mailing Address - Country:US
Mailing Address - Phone:502-909-5347
Mailing Address - Fax:520-296-3889
Practice Address - Street 1:2101 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6508
Practice Address - Country:US
Practice Address - Phone:520-209-7700
Practice Address - Fax:520-209-7570
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist