Provider Demographics
NPI:1043434350
Name:HUBBARD, PAMELA RENEE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:RENEE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 PHEASANT CV
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-1809
Mailing Address - Country:US
Mailing Address - Phone:501-776-0401
Mailing Address - Fax:
Practice Address - Street 1:500 PINEHAVEN RD
Practice Address - Street 2:
Practice Address - City:BAUXITE
Practice Address - State:AR
Practice Address - Zip Code:72011-9263
Practice Address - Country:US
Practice Address - Phone:501-944-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP# 533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist