Provider Demographics
NPI:1053504258
Name:PAMALA D. MIZE, M.S. CCC-A
Entity Type:Organization
Organization Name:PAMALA D. MIZE, M.S. CCC-A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL AUDIOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMALA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:276-620-3546
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 1:105 WEST PINE ST
Practice Address - Street 2:#103
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1954
Practice Address - Country:US
Practice Address - Phone:276-620-3546
Practice Address - Fax:276-228-3546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000232231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518125OtherWMWA
VA171991OtherBLUECROSS/BLUESHIELD