Provider Demographics
NPI:1295066512
Name:SANTILLAN, PATTRA (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:PATTRA
Middle Name:
Last Name:SANTILLAN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 S KIRKWOOD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6100
Mailing Address - Country:US
Mailing Address - Phone:314-822-6297
Mailing Address - Fax:314-822-6298
Practice Address - Street 1:439 S KIRKWOOD RD STE 204
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6100
Practice Address - Country:US
Practice Address - Phone:314-822-6297
Practice Address - Fax:314-822-6298
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000144169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist