Healthcare Provider Details

I. General information

NPI: 1821771700
Provider Name (Legal Business Name): ELIZABETH ANN PATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7898 VETERANS MEMORIAL PKWY
SAINT PETERS MO
63376-5910
US

IV. Provider business mailing address

14 MARY BETH CT
O FALLON MO
63368-7980
US

V. Phone/Fax

Practice location:
  • Phone: 636-474-8676
  • Fax:
Mailing address:
  • Phone: 217-415-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2023027804
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: