Provider Demographics
NPI:1295974053
Name:PETTIBONE, WYNDI LOIS (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WYNDI
Middle Name:LOIS
Last Name:PETTIBONE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-2462
Mailing Address - Country:US
Mailing Address - Phone:518-370-0730
Mailing Address - Fax:
Practice Address - Street 1:4344 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2462
Practice Address - Country:US
Practice Address - Phone:518-370-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist