Provider Demographics
NPI:1396996849
Name:HACKETT, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HACKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13707 DALLAS DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7179
Mailing Address - Country:US
Mailing Address - Phone:727-378-5823
Mailing Address - Fax:727-378-5824
Practice Address - Street 1:13707 DALLAS DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7179
Practice Address - Country:US
Practice Address - Phone:727-378-5823
Practice Address - Fax:727-378-5824
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010082235Z00000X
FLSA11165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist