Individual
ELIZABETH RENEE PATRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
10110 AGORA PL, FORT WAYNE, IN 46804-8710
(260) 436-8591
Mailing address
10110 AGORA PL, FORT WAYNE, IN 46804-8710
(260) 436-8591
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22003502A
IN
Other
Enumeration date
11/07/2008
Last updated
11/07/2008
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