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General NPI Number Information
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NPI Number | 1861130270
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Entity Type | Individual
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Provider Name | KELLY PITRE MA, SLP
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Gender | Female
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 203 E PLAQUEMINE ST
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City | JENNINGS
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State | LA
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Zip | 70546-5853
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Country | US
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Telephone | 337-824-1357
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Fax | 337-824-6693
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Provider Business Mailing Address
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Address Line | 802 W JEFFERSON ST
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City | JENNINGS
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State | LA
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Zip | 70546-6348
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Country | US
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Telephone | 337-824-1357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4042
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License Number State | LA
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