Debora Jean Patrick, MA. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4794 Issued in MA

Practice address

61 Cooper St
Agawam, MA 01001-2149

Phone

(413) 786-8000

Fax

(413) 789-2359

NPI assigned

Mar 22, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750407722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 LYNCH PL",
            "city": "SOUTH HADLEY",
            "state": "MA",
            "postal_code": "010752305",
            "telephone_number": "413-536-0459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 COOPER ST",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010012149",
            "telephone_number": "413-786-8000",
            "fax_number": "413-789-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "DEBORA",
        "middle_name": "JEAN",
        "credential": "MA. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": "4794",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "003272",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Marie O'Connor, DACM, MSTOM
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• Kristen Opitz, OT
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• Linda Ann Pezzini, OTR
• Lillian Pham, DMD
• Phases Mental Health Services, LLC
• Joelle Lynn Phillips

• Speech-Language Pathologist in Agawam, MA
• Providers in Agawam, MA by specialty
• Speech-Language Pathologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.