Provider Demographics
NPI:1396801221
Name:DELUKE, PATRICIA ANNE (SLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
Last Name:DELUKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 DUVAL RD APT F23
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6853
Mailing Address - Country:US
Mailing Address - Phone:409-718-7859
Mailing Address - Fax:
Practice Address - Street 1:1611 HEADWAY CIR BLDG 2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5165
Practice Address - Country:US
Practice Address - Phone:512-615-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004639301Medicaid