Provider Demographics
NPI:1760507362
Name:GORMAN, PATRICIA SPILSBURY (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:SPILSBURY
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:DIANE
Other - Last Name:SPILSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:PO BOX 750622
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175
Mailing Address - Country:US
Mailing Address - Phone:504-269-0105
Mailing Address - Fax:
Practice Address - Street 1:306 STATE STREET
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-701-3257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist