Provider Demographics
NPI:1386751279
Name:HERRINGTON, PATRICIA LEE (M ED, CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LEE
Last Name:HERRINGTON
Suffix:
Gender:F
Credentials:M ED, CCC/SLP
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:LAREE'
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4943 SW 95TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3412
Mailing Address - Country:US
Mailing Address - Phone:954-252-7591
Mailing Address - Fax:954-252-7591
Practice Address - Street 1:4943 SW 95TH AVE
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3412
Practice Address - Country:US
Practice Address - Phone:954-252-7591
Practice Address - Fax:954-252-7591
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4272235Z00000X
VT144.0132034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL830040200Medicaid