Basic Information
| Provider Information | |||||||||
| NPI: | 1396245544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TURNER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 S HOLDEN STREET | ||||||||
| Address2: | PO BOX 638 | ||||||||
| City: | WARRENSBURG | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6607477823 | ||||||||
| FaxNumber: | 6607479615 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 S HOLDEN STREET | ||||||||
| Address2: | PO BOX 638 | ||||||||
| City: | WARRENSBURG | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6607477823 | ||||||||
| FaxNumber: | 6607479615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2018 | ||||||||
| LastUpdateDate: | 02/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 460001655 | 05 | MO | MEDICAID |