Healthcare Provider Details

I. General information

NPI: 1477667715
Provider Name (Legal Business Name): PATRICIA A CUNNINGHAM CCC A SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA A WONG CCC A SLP

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 MEADOWOOD LN #150
RENO NV
89502
US

IV. Provider business mailing address

1698 MEADOWOOD LN #150
RENO NV
89502
US

V. Phone/Fax

Practice location:
  • Phone: 775-825-6012
  • Fax: 775-825-3331
Mailing address:
  • Phone: 775-825-6012
  • Fax: 775-825-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA053
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP223
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberA053
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: