Provider Demographics
NPI:1063490506
Name:OVERLY, PATRICIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:OVERLY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:OVERLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:USNH YOKOSUKA JAPAN
Mailing Address - Street 2:PSC 475 BOX 1
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350
Mailing Address - Country:JP
Mailing Address - Phone:01194-243-5564
Mailing Address - Fax:
Practice Address - Street 1:USNH YOKOSUKA JAPAN
Practice Address - Street 2:PSC 475 BOX 1
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96350
Practice Address - Country:JP
Practice Address - Phone:01194-243-5564
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22002518OtherSPEECH PATHOLOGIST LICENS