Provider Demographics
NPI:1568927481
Name:LAVALLIE, PATRICK DENNIS
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:DENNIS
Last Name:LAVALLIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 TRAFALGAR WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-7906
Mailing Address - Country:US
Mailing Address - Phone:954-675-8842
Mailing Address - Fax:
Practice Address - Street 1:1010 US 27 N
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2556
Practice Address - Country:US
Practice Address - Phone:863-453-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty