Provider Demographics
NPI:1316417587
Name:TRAUTWEIN, PAMELA FIRESTONE (MS, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:FIRESTONE
Last Name:TRAUTWEIN
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1518
Mailing Address - Country:US
Mailing Address - Phone:301-914-1351
Mailing Address - Fax:301-334-7642
Practice Address - Street 1:40 S 2ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1518
Practice Address - Country:US
Practice Address - Phone:301-914-1351
Practice Address - Fax:301-334-7642
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD541388500Medicaid
MD905202000Medicaid