Healthcare Provider Details

I. General information

NPI: 1609006998
Provider Name (Legal Business Name): PATRIKA WILLIBY-KING B.S.,SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 42ND ST APT 120
KENNER LA
70065-8200
US

IV. Provider business mailing address

2160 42ND ST APT 120
KENNER LA
70065-8200
US

V. Phone/Fax

Practice location:
  • Phone: 504-717-6634
  • Fax:
Mailing address:
  • Phone: 504-717-6634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6114
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: