Provider Demographics
NPI:1386961829
Name:PATTERSON, WYNNE ELIZABETH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:WYNNE
Middle Name:ELIZABETH
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-0484
Mailing Address - Country:US
Mailing Address - Phone:860-677-4048
Mailing Address - Fax:
Practice Address - Street 1:51 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3821
Practice Address - Country:US
Practice Address - Phone:860-404-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist