Provider Demographics
NPI:1558842351
Name:STOREY, PAMELA A (CLINSCD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:A
Last Name:STOREY
Suffix:
Gender:F
Credentials:CLINSCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 N MAIN RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-1734
Mailing Address - Country:US
Mailing Address - Phone:401-741-8812
Mailing Address - Fax:
Practice Address - Street 1:87 BIRDSONG WAY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-1365
Practice Address - Country:US
Practice Address - Phone:843-689-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00588235Z00000X
SC5343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist