Provider Demographics
NPI:1720487192
Name:PATTON, KHAKLIA ANGHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KHAKLIA
Middle Name:ANGHELLE
Last Name:PATTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 SMALLWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-2522
Mailing Address - Country:US
Mailing Address - Phone:601-214-8378
Mailing Address - Fax:
Practice Address - Street 1:1889 SMALLWOOD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-2522
Practice Address - Country:US
Practice Address - Phone:601-214-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist