Elizabeth Renee Patrick, MA CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

22003502A Issued in IN

Practice address

10110 Agora PL
Fort Wayne, IN 46804-8710

Phone

(260) 436-8591

NPI assigned

Nov 7, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Creative Health Care Management LLC

  • Physical Therapist
  • Fishers, IN
  • NPI 1902350457

  Speech-Language Pathologist

  Medicare reassignment NPD
• Creative Health Care Management LLC

  • Physical Therapist
  • Kansas City, KS
  • NPI 1033866975

  Speech-Language Pathologist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226016000000",
    "number": "1104070812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10110 AGORA PL",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468048710",
            "telephone_number": "260-436-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10110 AGORA PL",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468048710",
            "telephone_number": "260-436-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "ELIZABETH",
        "middle_name": "RENEE",
        "credential": "MA CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-07",
        "last_updated": "2008-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22003502A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pathway ABA LLC
• Smitha Patibandla, MD
• Patient First Rehabilitation LLC
• Patients Choice Medical and Wellness Clinic
• Alaina C Patrick
• Charles R Pattan, M.D.
• Tabitha Patten, PA
• Aaliyah Patterson
• Andrea Marie Patterson, MD
• Gregory Patterson II

• Speech-Language Pathologist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Speech-Language Pathologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.