Provider Demographics
NPI:1083113716
Name:TOLLEY, PATRICIA BANKS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:BANKS
Last Name:TOLLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 STAR MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-1107
Mailing Address - Country:US
Mailing Address - Phone:276-783-3021
Mailing Address - Fax:
Practice Address - Street 1:121 BAGLEY CIR STE 300
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-3140
Practice Address - Country:US
Practice Address - Phone:276-783-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01029392OtherASHA
VA2202003963OtherVIRGINIA DEPT. OF HEALTH PROFESSIONALS