Healthcare Provider Details

I. General information

NPI: 1194163840
Provider Name (Legal Business Name): LAURA PATTON MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA TWEEDY

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22864 PERIMETER DRIVE
LEBANON MO
65536
US

IV. Provider business mailing address

PO BOX 1023
LEBANON MO
65536-1023
US

V. Phone/Fax

Practice location:
  • Phone: 417-532-6528
  • Fax: 417-532-2435
Mailing address:
  • Phone: 417-532-6528
  • Fax: 417-532-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2012022390
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: