Provider Demographics
NPI:1114012176
Name:FEEHAN, PAMELA JO (AUD CCCA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:FEEHAN
Suffix:
Gender:F
Credentials:AUD CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8475
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-8475
Mailing Address - Country:US
Mailing Address - Phone:605-348-7706
Mailing Address - Fax:
Practice Address - Street 1:30 KNOLLWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-0695
Practice Address - Country:US
Practice Address - Phone:605-348-7706
Practice Address - Fax:605-716-2614
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD007A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5834250Medicaid