Provider Demographics
NPI:1104057355
Name:PATZ, PAMELA ELAINE (MS/CCC/SLP)
Entity type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:ELAINE
Last Name:PATZ
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 SLEEPY VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2921
Mailing Address - Country:US
Mailing Address - Phone:703-923-0727
Mailing Address - Fax:
Practice Address - Street 1:6929 MATTHEW PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3607
Practice Address - Country:US
Practice Address - Phone:703-256-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist