Provider Demographics
NPI:1174817969
Name:SPICKNALL, PATRICIA MCWHORTER (SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MCWHORTER
Last Name:SPICKNALL
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 1:3106 SPRING HILL PKWY SE
Mailing Address - Street 2:APT G
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4797
Mailing Address - Country:US
Mailing Address - Phone:770-601-9773
Mailing Address - Fax:
Practice Address - Street 1:3106 SPRING HILL PKWY SE
Practice Address - Street 2:APT G
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4797
Practice Address - Country:US
Practice Address - Phone:770-601-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist