Provider Demographics
NPI:1134652290
Name:GORHAM, PAMELA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GORHAM
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 1:5 FIELDSTEAD CT
Mailing Address - Street 2:APT B
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5214
Mailing Address - Country:US
Mailing Address - Phone:252-578-3869
Mailing Address - Fax:
Practice Address - Street 1:5009 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5353
Practice Address - Country:US
Practice Address - Phone:410-325-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist