Provider Demographics
NPI:1700959616
Name:PRELOCK, PATRICIA ANN (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:PRELOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF VERMONT
Mailing Address - Street 2:489 MAIN STREET POMEROY HALL
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:06405-0130
Mailing Address - Country:US
Mailing Address - Phone:802-656-3861
Mailing Address - Fax:802-656-2528
Practice Address - Street 1:UNIVERSITY OF VERMONT
Practice Address - Street 2:489 MAIN STREET POMEROY HALL
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:06405-0130
Practice Address - Country:US
Practice Address - Phone:802-656-3861
Practice Address - Fax:802-656-2528
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP2054235Z00000X
PASL000073L235Z00000X
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
49734OtherBLUE CROSS BLUE SHIELD
66V012OtherMVP