Provider Demographics
NPI:1417208216
Name:PATTERSON, CONNIE RISEN (SLP)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:RISEN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18084 GODDARD ST
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:KS
Mailing Address - Zip Code:66013-9083
Mailing Address - Country:US
Mailing Address - Phone:910-736-1992
Mailing Address - Fax:
Practice Address - Street 1:18084 GODDARD ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:KS
Practice Address - Zip Code:66013-9083
Practice Address - Country:US
Practice Address - Phone:910-736-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3967235Z00000X
CA24636235Z00000X
NC9680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist