Provider Demographics
NPI:1275214942
Name:ATKINSON, PATRICK (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 VERNON ST APT 6
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1440
Mailing Address - Country:US
Mailing Address - Phone:916-914-3032
Mailing Address - Fax:
Practice Address - Street 1:650 VERNON ST APT 6
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1440
Practice Address - Country:US
Practice Address - Phone:916-914-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19205235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist