Provider Demographics
NPI:1023336781
Name:LOWERY, PATRICIA WALTERS (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:WALTERS
Last Name:LOWERY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:WALTERS-LOWERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2 OAK LANDING RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-9031
Mailing Address - Country:US
Mailing Address - Phone:910-297-3417
Mailing Address - Fax:
Practice Address - Street 1:2 OAK LANDING RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-9031
Practice Address - Country:US
Practice Address - Phone:910-297-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist