Provider Demographics
NPI:1962519470
Name:IMITOLA- PEREZ, PATRICIA (SLP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:IMITOLA- PEREZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:PATY
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:1404 NE PARVIN RD
Mailing Address - Street 2:APT. # 208
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-5010
Mailing Address - Country:US
Mailing Address - Phone:816-756-0780
Mailing Address - Fax:
Practice Address - Street 1:3101 MAIN ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1921
Practice Address - Country:US
Practice Address - Phone:816-756-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006015398235Z00000X
KST-SLP: 2421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist