Healthcare Provider Details

I. General information

NPI: 1336396043
Provider Name (Legal Business Name): MARANDA GAYLE PATTERSON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 PETERS CREEK RD
ROANOKE VA
24019-3852
US

IV. Provider business mailing address

1221 COLONIAL RD
BLUE RIDGE VA
24064-1716
US

V. Phone/Fax

Practice location:
  • Phone: 540-366-2243
  • Fax: 540-366-4801
Mailing address:
  • Phone: 540-655-8685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202004989
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: