Provider Demographics
NPI:1285391268
Name:GATTO-WALDEN, PATRICIA ANN (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:GATTO-WALDEN
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 1:2845 S FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-2337
Mailing Address - Country:US
Mailing Address - Phone:217-840-0220
Mailing Address - Fax:
Practice Address - Street 1:1314 MAIN ST UNIT 204
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1586
Practice Address - Country:US
Practice Address - Phone:217-840-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2814103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling