Provider Demographics
NPI:1750508875
Name:WOLCOTT, PATRICIA M
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:WOLCOTT
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 1:701 MANATEE AVE W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8604
Mailing Address - Country:US
Mailing Address - Phone:941-749-5222
Mailing Address - Fax:941-749-1839
Practice Address - Street 1:701 MANATEE AVE W
Practice Address - Street 2:SUITE 201
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8604
Practice Address - Country:US
Practice Address - Phone:941-749-5222
Practice Address - Fax:941-749-1839
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA0001059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8207561OtherAETNA
FL34209A006OtherCHAMPUS
FLS1123OtherBCBS