Provider Demographics
NPI:1649954074
Name:PATTERSON, DEBORAH ANNE (MS SLP-CCC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 MARIGOLD DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1112
Mailing Address - Country:US
Mailing Address - Phone:808-772-1913
Mailing Address - Fax:
Practice Address - Street 1:4520 MONTGOMERY BLVD NE STE 3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1291
Practice Address - Country:US
Practice Address - Phone:505-883-3787
Practice Address - Fax:505-830-0106
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP-2023-0138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty