Provider Demographics
NPI:1972631133
Name:REDICAN, PATRICIA GRACE
Entity type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:GRACE
Last Name:REDICAN
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 1:133 HALLOCK LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8939
Mailing Address - Country:US
Mailing Address - Phone:631-384-8860
Mailing Address - Fax:
Practice Address - Street 1:SOUND THERAPEUTICS
Practice Address - Street 2:ROUTE 25A
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764
Practice Address - Country:US
Practice Address - Phone:631-821-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015595-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist