MEDICARE: ELIZABETH PATRICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146012208	IL

General Provider Information

NPI Number	:	1194244301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH PATRICK

Provider Business Mailing Address
First Line	:	400 BROADWAY
Second Line	:
City	:	HIGHLAND
State	:	IL
Zip	:	62249-2024
Country	:	US
Telephone Number	:	618-654-2106
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 LINDENTHAL AVE
Second Line	:
City	:	HIGHLAND
State	:	IL
Zip	:	62249-2203
Country	:	US
Telephone Number	:	618-654-2107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	09/19/2017

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Directions to “ ELIZABETH PATRICK ” Practice Location

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