Provider Demographics
NPI:1053432088
Name:WERTZ, PATRICIA MARIA (SLP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARIA
Last Name:WERTZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 LEA DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8248
Mailing Address - Country:US
Mailing Address - Phone:610-455-1561
Mailing Address - Fax:
Practice Address - Street 1:3975 CONSHOHOCKEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-5426
Practice Address - Country:US
Practice Address - Phone:215-879-1000
Practice Address - Fax:215-879-3912
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003962L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019330790004Medicaid