Provider Demographics
NPI:1144745100
Name:PATTEN, AMANDA
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:PATTEN
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 1:990 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CARBON HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60416-7008
Mailing Address - Country:US
Mailing Address - Phone:815-954-6904
Mailing Address - Fax:
Practice Address - Street 1:300 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1043
Practice Address - Country:US
Practice Address - Phone:815-634-2334
Practice Address - Fax:815-954-6904
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist