Provider Demographics
NPI:1285202812
Name:PATNOUDES, MAGGIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:PATNOUDES
Suffix:
Gender:F
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 1:656 LONESOME PINE TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3816
Mailing Address - Country:US
Mailing Address - Phone:269-930-2077
Mailing Address - Fax:
Practice Address - Street 1:656 LONESOME PINE TRL
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3816
Practice Address - Country:US
Practice Address - Phone:269-930-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty