Provider Demographics
NPI:1710210075
Name:KIRKPATRICK, TAMMI SUE
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:SUE
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1527
Mailing Address - Country:US
Mailing Address - Phone:573-651-4042
Mailing Address - Fax:
Practice Address - Street 1:2506 ABBEY RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1527
Practice Address - Country:US
Practice Address - Phone:573-651-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005000363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005000363OtherMISSOURI LICENSE NUMBER