Provider Demographics
NPI:1003880857
Name:ARCHER, PATRICIA ANN (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:ARCHER
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSP,CCC-SLP
Mailing Address - Street 1:11026 ASBURY CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4625
Mailing Address - Country:US
Mailing Address - Phone:704-575-4222
Mailing Address - Fax:704-875-7112
Practice Address - Street 1:11026 ASBURY CHAPEL RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4625
Practice Address - Country:US
Practice Address - Phone:704-575-4222
Practice Address - Fax:704-875-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411433Medicaid
NC7212148Medicaid