Provider Demographics
NPI:1568593853
Name:STITH, PATRICIA JANE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JANE
Last Name:STITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:JANE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:KY
Mailing Address - Zip Code:42740-0153
Mailing Address - Country:US
Mailing Address - Phone:270-369-8495
Mailing Address - Fax:270-369-0099
Practice Address - Street 1:226 SOUTH BELL AVENUE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:KY
Practice Address - Zip Code:42740-0153
Practice Address - Country:US
Practice Address - Phone:270-369-8495
Practice Address - Fax:270-369-0099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1376235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist