Provider Demographics
NPI:1497063689
Name:DONOVAN, PAMELA S (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND PATENT
Mailing Address - State:NY
Mailing Address - Zip Code:13354-4618
Mailing Address - Country:US
Mailing Address - Phone:315-865-5721
Mailing Address - Fax:
Practice Address - Street 1:9601 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLAND PATENT
Practice Address - State:NY
Practice Address - Zip Code:13354-4618
Practice Address - Country:US
Practice Address - Phone:315-865-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 009957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist