Provider Demographics
NPI:1821421561
Name:DAWKINS, PATRISE CORLEY (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRISE
Middle Name:CORLEY
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 KINGSLAND WAY
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-7769
Mailing Address - Country:US
Mailing Address - Phone:864-845-8962
Mailing Address - Fax:
Practice Address - Street 1:126 KINGSLAND WAY
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7769
Practice Address - Country:US
Practice Address - Phone:864-845-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1104973577Medicaid