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MRS. KIMBERLY PETTIS M.S.CCC-SLP
NPI 1689739914
Speech-Language Pathologist in Port Jefferson, NY

Active since December 27, 2006
200 BELLE TERRE RD, PORT JEFFERSON, NY 11777(631) 474-6263 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mrs. Kimberly Pettis M.s.ccc-slp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. KIMBERLY PETTIS M.S.CCC-SLP (NPI 1689739914) is an individual speech-language pathologist provider in Port Jefferson, New York, licensed in New York (012235-1) and active in the NPI registry since December 2006.

NPPES Registry Identity

NPI1689739914
Entity TypeIndividualFemale
Primary Taxonomy235Z00000X
Provider Legal NameMRS. KIMBERLY PETTISCredential: M.S.CCC-SLP
Location Address200 BELLE TERRE RDPort Jefferson, NY 11777-1928
Mailing Address7 Robin DrHauppauge, NY 11788-1104 · (631) 656-8180
Phone(631) 474-6263
Sole ProprietorNo
Enumeration DateDecember 27, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1689739914 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpeech-Language PathologistSpeech, Language and Hearing Service Providers
Taxonomy Code235Z00000X
License✔ Licensed in NY · 012235-1
Definition
The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.
200 BELLE TERRE RD, Port Jefferson, NY 11777
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANTHONY BRIAN KWAN MD
Emergency Medicine
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6791
MR. TERENCE JOSEPH SCHULZ MA CCC-A
Audiologist-Hearing Aid Fitter
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6326
MS. LAURA LYNN BECK PT
Physical Therapist
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 476-5606
RONNI MARANGONI
Occupational Therapist (Pediatrics)
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6267
IGOR LIZOGUBENKO P.A.
Physician Assistant
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6000
SANA AMBER HAMEEDI D.O
Pediatrics
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6000
MR. MATTHEW DELPH PA
Physician Assistant
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6000
DR. ROBERT KENNEDY AWADALLAH PHARM.D, ANP, MBA
Pharmacist
200 BELLE TERRE RD
PORT JEFFERSON, NY 11777
Suffolk County (631) 474-6000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kimberly Pettis's NPI number?

The NPI number for Kimberly Pettis is 1689739914. It was assigned to this individual provider in the NPPES registry on December 27, 2006.

Where is Kimberly Pettis located?

Kimberly Pettis practices at 200 Belle Terre Rd, Port Jefferson, NY 11777. The listed phone number is (631) 474-6263.

What is Kimberly Pettis's specialty?

The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.

When was this NPI record last updated?

The NPPES record for Kimberly Pettis was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.