Provider Demographics
NPI:1518085455
Name:FOOTE, PATRICIA BONNER
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:BONNER
Last Name:FOOTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637STATE ROUTE973WEST
Mailing Address - Street 2:
Mailing Address - City:COGAN STATION
Mailing Address - State:PA
Mailing Address - Zip Code:17728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:743 MAHONING ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-2232
Practice Address - Country:US
Practice Address - Phone:570-742-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASLOO3772L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist