Organization
409 THERAPY SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA PETTY M.S. CCC-SLP (OWNER / OPERATOR)
(409) 289-1426
Entity
Organization
Contact information
Practice address
139 PRIVATE ROAD 5396, KIRBYVILLE, TX 75956-3235
(409) 449-5498
(409) 449-6079
Mailing address
139 PRIVATE ROAD 5396, KIRBYVILLE, TX 75956-3235
(409) 289-1426
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457784167
—
TX
Enumeration date
05/18/2022
Last updated
06/27/2022
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