Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Kimberly Pettis, MSCCC-SLP

Individual provider Speech-Language Pathologist · NPI 1689739914

Mrs. Kimberly Pettis, MSCCC-SLP is a Speech-Language Pathologist in Port Jefferson, New York. Licensed in New York. Registered with an NPI since 2006.

Licensed in
NY
In the registry since
2006

Practice location Address checks out

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone: (631) 474-6263
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 012235-1 (NY)

Record details

NPI number1689739914
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSCCC-SLP
Sole proprietorNo
NPI enumeratedDecember 27, 2006
Last updated in NPPESJuly 8, 2007

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