Provider Demographics
NPI:1346617073
Name:SLOAN, PAMELA (MED)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MED
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 504
Mailing Address - Street 2:
Mailing Address - City:BARLOW
Mailing Address - State:KY
Mailing Address - Zip Code:42024-0504
Mailing Address - Country:US
Mailing Address - Phone:270-836-9417
Mailing Address - Fax:
Practice Address - Street 1:241 ROBERTSON DR
Practice Address - Street 2:
Practice Address - City:BARLOW
Practice Address - State:KY
Practice Address - Zip Code:42024-9584
Practice Address - Country:US
Practice Address - Phone:270-836-9417
Practice Address - Fax:877-777-3137
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00222209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional