Angela Michelle Pettitt, M.S., L-SLP, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

8502 Issued in LA

Practice address

23946 Southpark LN
Denham Springs, LA 70726-6898

Phone

(225) 276-4190

NPI assigned

Jul 31, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Livingston Parish School System

  • Student Health Clinic/Center
  • Livingston, LA
  • NPI 1194937631
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1568072932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1130",
            "city": "LIVINGSTON",
            "state": "LA",
            "postal_code": "707541130",
            "telephone_number": "225-665-0446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23946 SOUTHPARK LN",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707266898",
            "telephone_number": "225-276-4190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTITT",
        "first_name": "ANGELA",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "M.S., L-SLP, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-31",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "8502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2644441",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pauline Pham, DDS
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• Phazyle Beauty Parlor by Paisley

• Speech-Language Pathologist in Denham Springs, LA
• Providers in Denham Springs, LA by specialty
• Speech-Language Pathologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.