Provider Demographics
NPI:1780971150
Name:KITTTENPLAN, PATRICIA JOY (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JOY
Last Name:KITTTENPLAN
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MONACO CT
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4590
Mailing Address - Country:US
Mailing Address - Phone:631-698-7359
Mailing Address - Fax:
Practice Address - Street 1:301 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2080
Practice Address - Country:US
Practice Address - Phone:631-588-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist