Provider Demographics
NPI:1275830614
Name:MCCASKILL, PAMELA STOUT (SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:STOUT
Last Name:MCCASKILL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 ZICKERT RD NW
Mailing Address - Street 2:DURANES ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-2831
Mailing Address - Country:US
Mailing Address - Phone:505-764-2018
Mailing Address - Fax:
Practice Address - Street 1:2436 ZICKERT RD NW
Practice Address - Street 2:DURANES ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2831
Practice Address - Country:US
Practice Address - Phone:505-764-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC 4864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNEDMedicaid