Provider Demographics
NPI:1437346673
Name:SMITH, PAMELA ELIZABETH (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1800 PENN ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2625
Mailing Address - Country:US
Mailing Address - Phone:321-536-6761
Mailing Address - Fax:321-768-6858
Practice Address - Street 1:1800 PENN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2625
Practice Address - Country:US
Practice Address - Phone:321-536-6761
Practice Address - Fax:321-768-6858
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist