1760507362 NPI number — MRS. PATRICIA SPILSBURY GORMAN MA CCC SLP

Table of content: MRS. PATRICIA SPILSBURY GORMAN MA CCC SLP (NPI 1760507362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760507362 NPI number — MRS. PATRICIA SPILSBURY GORMAN MA CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORMAN
Provider First Name:
PATRICIA
Provider Middle Name:
SPILSBURY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPILSBURY
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA CCC SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760507362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 750622
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-269-0105
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 STATE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-701-3257
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  3108 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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