Provider Demographics
NPI:1285777425
Name:BIRDSONG, PATRICIA ELLEN (MA, SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELLEN
Last Name:BIRDSONG
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 OLD US HIGHWAY 421
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28679-9549
Mailing Address - Country:US
Mailing Address - Phone:828-297-6363
Mailing Address - Fax:
Practice Address - Street 1:683 OLD US HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:NC
Practice Address - Zip Code:28679-9549
Practice Address - Country:US
Practice Address - Phone:828-297-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411449Medicaid