MEDICARE: MEGAN PETTIETTE M.S., CCC-SLP

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1942708805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN PETTIETTE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	203 BUSHWHACKER DR
Second Line	:
City	:	MABANK
State	:	TX
Zip	:	75156-7211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 E PARK AVE
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4500
Country	:	US
Telephone Number	:	972-965-9401
Fax Number	:

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

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	12/05/2025

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Directions to “ MEGAN PETTIETTE M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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