Provider Demographics
NPI:1063661601
Name:GROTH, PAMELA W (CCC-LSLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:W
Last Name:GROTH
Suffix:
Gender:F
Credentials:CCC-LSLP
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:JOAN
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:137 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1901
Mailing Address - Country:US
Mailing Address - Phone:716-372-6768
Mailing Address - Fax:
Practice Address - Street 1:1825 WINDFALL RD
Practice Address - Street 2:BOCES CENTER AT OLEAN
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-9303
Practice Address - Country:US
Practice Address - Phone:716-375-8093
Practice Address - Fax:716-375-8278
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003756-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist