MEDICARE: MIKALA L PATTERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1275119703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKALA L PATTERSON

Provider Business Mailing Address
First Line	:	1301 E ORANGEWOOD AVE
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92805-6807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 S TEJON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2231
Country	:	US
Telephone Number	:	800-249-1266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/23/2021

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Directions to “ MIKALA L PATTERSON ” Practice Location

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