Provider Demographics
NPI:1043354301
Name:MIZE, PAMALA DAWN (MS CCC-A)
Entity Type:Individual
Prefix:PROF
First Name:PAMALA
Middle Name:DAWN
Last Name:MIZE
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 W PINE ST
Mailing Address - Street 2:# 103
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1954
Mailing Address - Country:US
Mailing Address - Phone:276-620-3546
Mailing Address - Fax:276-228-3546
Practice Address - Street 1:360 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1185
Practice Address - Country:US
Practice Address - Phone:276-620-3546
Practice Address - Fax:276-228-3546
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000232231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518125OtherFUNDS (UMWA) AUDIOLOGY
VA171991OtherANTHEM BCBS AUDIOLOGY
VA9450688Medicaid