Provider Demographics
NPI:1770952780
Name:WALDEN, PATRICK ROY (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ROY
Last Name:WALDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SHORELAND TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-6201
Mailing Address - Country:US
Mailing Address - Phone:917-513-6503
Mailing Address - Fax:
Practice Address - Street 1:400 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1898
Practice Address - Country:US
Practice Address - Phone:917-513-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-20
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016540235Z00000X
NJ41YS01131900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist