Provider Demographics
NPI:1417123514
Name:CRAFT, PAM
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:CRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E LESLIE AVE
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MO
Mailing Address - Zip Code:64790-9177
Mailing Address - Country:US
Mailing Address - Phone:417-465-2221
Mailing Address - Fax:
Practice Address - Street 1:216 E LESLIE AVE
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MO
Practice Address - Zip Code:64790-9177
Practice Address - Country:US
Practice Address - Phone:417-465-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006014625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist