Provider Demographics
NPI:1558375444
Name:STOVALL, PAMELA KAYE (MCD, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAYE
Last Name:STOVALL
Suffix:
Gender:F
Credentials:MCD, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MO
Mailing Address - Zip Code:65483-2602
Mailing Address - Country:US
Mailing Address - Phone:417-257-3509
Mailing Address - Fax:417-967-1078
Practice Address - Street 1:7519 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MO
Practice Address - Zip Code:65483-2602
Practice Address - Country:US
Practice Address - Phone:417-257-3509
Practice Address - Fax:417-967-1078
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist