Provider Demographics
NPI:1356137293
Name:PRITCHETT, BERNETTA DEDEAUX
Entity type:Individual
Prefix:
First Name:BERNETTA
Middle Name:DEDEAUX
Last Name:PRITCHETT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 TOMMY MUNRO DR STE A
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2139
Mailing Address - Country:US
Mailing Address - Phone:228-493-6330
Mailing Address - Fax:
Practice Address - Street 1:962 TOMMY MUNRO DR STE A
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2139
Practice Address - Country:US
Practice Address - Phone:228-207-4393
Practice Address - Fax:228-256-6036
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSSA-4472355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant