Provider Demographics
NPI:1457501637
Name:RYDELL, PATRICK JOHN (DR)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JOHN
Last Name:RYDELL
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 620578
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80162
Mailing Address - Country:US
Mailing Address - Phone:303-985-1133
Mailing Address - Fax:720-962-0678
Practice Address - Street 1:3636 S. INDEPENDENCE ST.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235
Practice Address - Country:US
Practice Address - Phone:303-985-1133
Practice Address - Fax:720-962-0678
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00824284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31401848Medicaid