MEDICARE: MS. JANET M PETITTE MS CCC/A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AT-005891	PA
2	231H00000X	Audiologist	A-0177	WV
3	231H00000X	Audiologist	4258	SC

General Provider Information

NPI Number	:	1558519009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET M PETITTE MS CCC/A

Provider Business Mailing Address
First Line	:	750 N COMMONS DR STE 200
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-7940
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	1801 OLD TROLLEY RD STE 101
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8283
Country	:	US
Telephone Number	:	843-871-3235
Fax Number	:	843-871-3233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	01/04/2024

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