Provider Demographics
NPI:1609006998
Name:WILLIBY-KING, PATRIKA (BS,SLPA)
Entity Type:Individual
Prefix:MRS
First Name:PATRIKA
Middle Name:
Last Name:WILLIBY-KING
Suffix:
Gender:F
Credentials:BS,SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 42ND ST APT 120
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-8200
Mailing Address - Country:US
Mailing Address - Phone:504-717-6634
Mailing Address - Fax:
Practice Address - Street 1:2160 42ND ST APT 120
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-8200
Practice Address - Country:US
Practice Address - Phone:504-717-6634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA61142355S0801X
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health