Provider Demographics
NPI:1457665242
Name:PATRICK, TONI MICHELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:MICHELLE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:TONI
Other - Middle Name:MICHELLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1876 NE HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4833
Mailing Address - Country:US
Mailing Address - Phone:541-382-5531
Mailing Address - Fax:541-383-1684
Practice Address - Street 1:1876 NE HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4833
Practice Address - Country:US
Practice Address - Phone:541-382-5531
Practice Address - Fax:541-383-1684
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist