Basic Information
| Provider Information | |||||||||
| NPI: | 1497936348 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PODRAZIK | ||||||||
| FirstName: | PATRICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4301 NTH 25TH STREET | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023938292 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 NTH HIGHLANDS PARKWAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984063226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537527112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2007 | ||||||||
| LastUpdateDate: | 01/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP5706 | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.