Healthcare Provider Details

I. General information

NPI: 1811265481
Provider Name (Legal Business Name): PATRICIA ELIZABETH DUGAN LICENSED SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W MAIN ST
BROCTON NY
14716-9749
US

IV. Provider business mailing address

8685 ERIE RD
ANGOLA NY
14006-9620
US

V. Phone/Fax

Practice location:
  • Phone: 716-792-2100
  • Fax: 716-792-2260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: