Individual
MS. LINDA DIANNE PETTICREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED. CCC-A
Contact information
Practice address
1300 KUHL AVE, MP 116, ORLANDO, FL 32806-2006
(321) 841-6144
(407) 649-8869
Mailing address
102 WEST PINELOCH AVENUE, SUITE 23, ORLANDO, FL 32806-6100
(407) 481-7173
(407) 481-7190
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY1005
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600419900
—
FL
05
—
811091300
—
FL
Enumeration date
11/16/2006
Last updated
06/11/2009
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