Provider Demographics
NPI:1457856478
Name:PATINO-GONZALEZ, ANNETTE MARLIESE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARLIESE
Last Name:PATINO-GONZALEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 412307
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2009
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:41 OLD OYSTER POINT RD STE E
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7177
Practice Address - Country:US
Practice Address - Phone:757-223-1466
Practice Address - Fax:757-233-1467
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist