Provider Demographics
NPI:1265566020
Name:PATTERSON, MARY JANE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:PATTERSON
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 1:12948 HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:QULIN
Mailing Address - State:MO
Mailing Address - Zip Code:63961-8260
Mailing Address - Country:US
Mailing Address - Phone:573-328-4026
Mailing Address - Fax:573-328-4883
Practice Address - Street 1:12948 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:QULIN
Practice Address - State:MO
Practice Address - Zip Code:63961-8260
Practice Address - Country:US
Practice Address - Phone:573-328-4026
Practice Address - Fax:573-328-4883
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child