Provider Demographics
NPI:1487030854
Name:KING, PATRICIA ANN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 CREEK RD
Mailing Address - Street 2:PO BOX 117
Mailing Address - City:UNION DALE
Mailing Address - State:PA
Mailing Address - Zip Code:18470
Mailing Address - Country:US
Mailing Address - Phone:570-727-2030
Mailing Address - Fax:
Practice Address - Street 1:851 COMMERCE BLVD #107
Practice Address - Street 2:THE AARON CENTER
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006267L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist