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General NPI Number Information
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NPI Number | 1265657936
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Entity Type | Individual
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Provider Name | STACEY JO PATTERSON MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 9128 E SAN SALVADOR DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5556
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Country | US
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Telephone | 480-767-8659
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Fax | 480-767-9776
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Provider Business Mailing Address
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Address Line | 8922 N 15TH LN
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City | PHOENIX
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State | AZ
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Zip | 85021-4372
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Country | US
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Telephone | 623-221-3614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP2109
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License Number State | AZ
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