Healthcare Provider Details

I. General information

NPI: 1497936348
Provider Name (Legal Business Name): PATRICK PODRAZIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 NTH HIGHLANDS PARKWAY
TACOMA WA
98406-3226
US

IV. Provider business mailing address

4301 NTH 25TH STREET
TACOMA WA
98406
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-7112
  • Fax:
Mailing address:
  • Phone: 602-393-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP5706
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: