Provider Demographics
NPI:1932228905
Name:SYLVAIN, PATRICE ADELE (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:ADELE
Last Name:SYLVAIN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 W CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3916
Mailing Address - Country:US
Mailing Address - Phone:832-364-3394
Mailing Address - Fax:
Practice Address - Street 1:2710 W CALDWELL ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3916
Practice Address - Country:US
Practice Address - Phone:832-364-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1769051Medicaid