Provider Demographics
NPI:1477746568
Name:BENBOW, PAMELA S (AUD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:BENBOW
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2329
Mailing Address - Country:US
Mailing Address - Phone:843-497-6156
Mailing Address - Fax:843-449-9946
Practice Address - Street 1:5913 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2329
Practice Address - Country:US
Practice Address - Phone:843-497-6156
Practice Address - Fax:843-449-9946
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC336231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0063Medicaid
SCSA0063Medicaid