Provider Demographics
NPI:1346393600
Name:IANNACITO, PATRICIA COSTELLO (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:COSTELLO
Last Name:IANNACITO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:TRISH
Other - Middle Name:COSTELLO
Other - Last Name:IANNACITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:717 ALEXANDRIA CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5623
Mailing Address - Country:US
Mailing Address - Phone:970-635-0129
Mailing Address - Fax:
Practice Address - Street 1:611 KORTE WAY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6366
Practice Address - Country:US
Practice Address - Phone:303-776-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist