Provider Demographics
NPI:1689834178
Name:MITSUDA, PATRICIA MALONEY (SLP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MALONEY
Last Name:MITSUDA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 28TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5515
Mailing Address - Country:US
Mailing Address - Phone:206-284-7012
Mailing Address - Fax:206-691-0615
Practice Address - Street 1:2717 DEXTER AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1914
Practice Address - Country:US
Practice Address - Phone:206-284-7012
Practice Address - Fax:206-691-0615
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist