Victoria Lynn Pattillo, MS CCC SLP

Individual provider Active NPI Speech-Language Pathologist · Saint Elmo, IL

NPI 1720146723 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1720146723
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
Practice address
RR 2 Box 251D
Saint Elmo, IL 62458-9586
Phone
(618) 829-9121
Fax
(618) 829-9121
NPI assigned
Dec 4, 2006
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
146004811ILMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Meraki Therapies Inc. Speech-Language Pathologist Past
since Nov 17, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X IL Yes

Addresses

Primary practice location

RR 2 Box 251D
Saint Elmo, IL 62458-9586

Mailing address

PO Box 21
Saint Elmo, IL 62458-0021
Phone (618) 829-9121

Other providers in Saint Elmo, IL

All providers in Saint Elmo, IL · Speech-Language Pathologist in Illinois

Sources for this page

Verify at the official NPI Registry.