# STEPHEN F. AUSTIN STATE UNIVERSITY COLE AUDIOLOGY LAB

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366604183
- **Authorized official:** DR. BAKER PATTILLO PH.D. (PRESIDENT)
- **Authorized official phone:** (936) 468-2201

## Contact information

- **Practice address:** 2100 N RAGUET, NO. 205, NACOGDOCHES, TX 75961
- **Practice address phone:** (936) 468-1252
- **Practice address fax:** (936) 468-7096
- **Mailing address:** 1936 N STREET AUSTIN 315, PO BOX 6145, SFA STATION, NACOGDOCHES, TX 75962-0001
- **Mailing address phone:** (936) 468-2201
- **Mailing address fax:** (936) 468-2202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 80104 | TX | Yes |

## Other

- **Enumeration date:** 07/02/2008
- **Last updated:** 07/02/2008