Provider Demographics
NPI:1164208831
Name:PATRICK, MARIAH WILSON (SLP)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:WILSON
Last Name:PATRICK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GLENWOOD
Mailing Address - Street 2:150 GLENWOOD LANE
Mailing Address - City:BIRMINGHAM,AL
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5700
Mailing Address - Country:US
Mailing Address - Phone:205-969-2880
Mailing Address - Fax:
Practice Address - Street 1:GLENWOOD
Practice Address - Street 2:150 GLENWOOD LANE
Practice Address - City:BIRMINGHAM,AL
Practice Address - State:AL
Practice Address - Zip Code:35242-5700
Practice Address - Country:US
Practice Address - Phone:205-969-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist