Provider Demographics
NPI:1902002702
Name:PATCH, DEIRDRE CLAIRE MULCAHY (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:CLAIRE MULCAHY
Last Name:PATCH
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BIRCH WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3854
Mailing Address - Country:US
Mailing Address - Phone:978-922-5960
Mailing Address - Fax:
Practice Address - Street 1:7 BIRCH WOODS DR
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3854
Practice Address - Country:US
Practice Address - Phone:978-922-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SP0057OtherBCBS
01074862OtherASHA
15581OtherNDTA
MA3017OtherSTATE LICENSE