Provider Demographics
NPI:1356369334
Name:HARRISON, PATRICIA ANN (MS, CCC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2594 SPREADING OAKS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6501
Mailing Address - Country:US
Mailing Address - Phone:904-386-4990
Mailing Address - Fax:904-260-0435
Practice Address - Street 1:3733 UNIVERSITY BLVD W STE 207
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2103
Practice Address - Country:US
Practice Address - Phone:904-386-4990
Practice Address - Fax:904-260-0435
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL882342101Medicaid