Provider Demographics
NPI:1124404629
Name:SLOUP, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SLOUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 COUNTY ROAD V
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:NE
Mailing Address - Zip Code:68050-6314
Mailing Address - Country:US
Mailing Address - Phone:402-480-0096
Mailing Address - Fax:402-443-4916
Practice Address - Street 1:2056 N HACKBERRY ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-5555
Practice Address - Country:US
Practice Address - Phone:402-443-4250
Practice Address - Fax:402-443-4916
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE866235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist