Provider Demographics
NPI:1043232903
Name:HENSON, PAMELA A (MS CCCSLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:HENSON
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 UNIVERSITY HALL DRIVE
Mailing Address - Street 2:ROOM 120
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-2041
Mailing Address - Country:US
Mailing Address - Phone:828-262-2185
Mailing Address - Fax:828-262-6766
Practice Address - Street 1:400 UNIVERSITY HALL DRIVE
Practice Address - Street 2:ROOM 120
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-2041
Practice Address - Country:US
Practice Address - Phone:828-262-2185
Practice Address - Fax:828-262-6766
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1348AOtherBCBS OF NC
NC7411019Medicaid