=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346995529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AAC ASSOCIATES SPEECH & LANGUAGE SPECIALTIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2022
-----------------------------------------------------
Last Update Date | 02/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 217 ALEXANDER DARIUS CT
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106-4364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-413-3947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 217 ALEXANDER DARIUS CT
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106-4364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-413-3947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FAATIMAH MALIKA PATTERSON
-----------------------------------------------------
Credential | M.S. CCC-SLP
-----------------------------------------------------
Telephone | 803-413-3947
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------