Provider Demographics
NPI:1700960382
Name:THORNTON, PATRICE ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:ELIZABETH
Last Name:THORNTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 DIFFEE DR
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5722
Mailing Address - Country:US
Mailing Address - Phone:918-431-1624
Mailing Address - Fax:
Practice Address - Street 1:2404 DIFFEE DR
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5722
Practice Address - Country:US
Practice Address - Phone:918-431-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist