Provider Demographics
NPI:1548601131
Name:MARIENTHAL, PAMELA PALMER (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:PALMER
Last Name:MARIENTHAL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 S JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4836
Mailing Address - Country:US
Mailing Address - Phone:417-622-4655
Mailing Address - Fax:
Practice Address - Street 1:2311 S JACKSON AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1936
Practice Address - Country:US
Practice Address - Phone:417-781-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist