Provider Demographics
NPI:1447618079
Name:WATHEN, PATRICIA (SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WATHEN
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 1:2498 DAYTON XENIA RD.
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434
Mailing Address - Country:US
Mailing Address - Phone:937-427-1919
Mailing Address - Fax:937-427-1949
Practice Address - Street 1:2498 DAYTON XENIA RD.
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434
Practice Address - Country:US
Practice Address - Phone:937-427-1919
Practice Address - Fax:937-427-1949
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.3547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist