Provider Demographics
NPI:1043836752
Name:PELLETIER, PRISCILLA (MS-SLP-CF)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:MS-SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 NE 1ST AVE UNIT 2502
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1846
Mailing Address - Country:US
Mailing Address - Phone:786-426-5095
Mailing Address - Fax:
Practice Address - Street 1:1140 W 50TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3440
Practice Address - Country:US
Practice Address - Phone:305-231-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist