Provider Demographics
NPI:1114358223
Name:PATTERSON, VANESSA (LMT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3084 LIVINGSTON RD APT 2
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3261
Mailing Address - Country:US
Mailing Address - Phone:216-694-1966
Mailing Address - Fax:
Practice Address - Street 1:7519 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5434
Practice Address - Country:US
Practice Address - Phone:440-882-6985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017281 N-R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist