Madeline Jean Pettry, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

1054 Issued in WV

Practice address

1015 Oakhurst Dr
Charleston, WV 25314-2049

Phone

(304) 345-8101

NPI assigned

Mar 3, 2025

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

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

Locations

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.

• Professional Therapy Services, Inc.

  • Speech-Language Pathologist
  • Charleston, WV
  • NPI 1962410605
  NPD

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

{
    "created_epoch": "1740960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1629875174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 NANCY ST",
            "city": "SETH",
            "state": "WV",
            "postal_code": "251819580",
            "telephone_number": "304-553-2734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 OAKHURST DR",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253142049",
            "telephone_number": "304-345-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTRY",
        "first_name": "MADELINE",
        "middle_name": "JEAN",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-03",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WV",
            "license": "1054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaniece Pettigrew
• Tiffany Pettigrew
• James Jarrett Pettit II, MD
• Haley Pettry
• Kyndra Pettry
• Mariah Delayna Pettry, B.S.
• Stephanie Pettry
• Timothy Pettry
• Louann Petts, M.A.
• Heather Peyatt

• Speech-Language Pathologist in Charleston, WV
• Providers in Charleston, WV by specialty
• Speech-Language Pathologist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; 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.