Provider Demographics
NPI:1710602933
Name:ELLIOTT, PATRICK DERMICO (SLP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DERMICO
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5300
Mailing Address - Country:US
Mailing Address - Phone:910-493-3555
Mailing Address - Fax:910-493-3520
Practice Address - Street 1:934 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5300
Practice Address - Country:US
Practice Address - Phone:910-493-3520
Practice Address - Fax:910-493-3520
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist