Individual
JERRELL PETTIGREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1048 WILDWOOD CENTRE DR, COLUMBIA, SC 29229-8420
(803) 999-3752
Mailing address
181 W PROFESSIONAL PARK CT STE 1, BOWLING GREEN, KY 42104-3250
(270) 777-9283
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
17-32371
SC
Other
Enumeration date
12/19/2017
Last updated
12/19/2017
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