Provider Demographics
NPI:1902963903
Name:PATTERSON, PATRICIA ALLISON (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ALLISON
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4319 WILTON ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2976
Mailing Address - Country:US
Mailing Address - Phone:850-228-1592
Mailing Address - Fax:
Practice Address - Street 1:118 ADRIS PL
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1997
Practice Address - Country:US
Practice Address - Phone:133-467-7636
Practice Address - Fax:133-467-8654
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2503235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist