Provider Demographics
NPI:1659411775
Name:SPILLANE, PATRICE M (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:M
Last Name:SPILLANE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:PATRICE
Other - Middle Name:B
Other - Last Name:MOSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1512 KESTREL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-1541
Mailing Address - Country:US
Mailing Address - Phone:704-789-3193
Mailing Address - Fax:
Practice Address - Street 1:461 POND APPLE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2208
Practice Address - Country:US
Practice Address - Phone:931-920-4333
Practice Address - Fax:931-920-4346
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3628235Z00000X
TN8243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist