Provider Demographics
NPI:1669616140
Name:ROE, PATRICIA LYNN (MHS, CCC, SLP/L)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LYNN
Last Name:ROE
Suffix:
Gender:F
Credentials:MHS, CCC, SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SYCAMORE CT
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5017
Mailing Address - Country:US
Mailing Address - Phone:773-485-8336
Mailing Address - Fax:
Practice Address - Street 1:39 SYCAMORE CT
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5017
Practice Address - Country:US
Practice Address - Phone:773-485-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-006395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist