MEDICARE: PATRICIA ALLISON PATTERSON M.S. CCC-SLP

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	2503	AL

General Provider Information

NPI Number	:	1902963903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ALLISON PATTERSON M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	4319 WILTON ST
Second Line	:
City	:	MARIANNA
State	:	FL
Zip	:	32446-2976
Country	:	US
Telephone Number	:	850-228-1592
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 ADRIS PL
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-1997
Country	:	US
Telephone Number	:	133-467-7636
Fax Number	:	133-467-8654

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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Directions to “ PATRICIA ALLISON PATTERSON M.S. CCC-SLP” Practice Location

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