Provider Demographics
NPI:1225261209
Name:BASHOR, PAMELA H (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:H
Last Name:BASHOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LILLINGTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3188
Mailing Address - Country:US
Mailing Address - Phone:704-375-5231
Mailing Address - Fax:
Practice Address - Street 1:320 LILLINGTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3188
Practice Address - Country:US
Practice Address - Phone:704-375-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0264NOtherBCBS