Provider Demographics
NPI:1588852321
Name:MCCUTCHEN, PAM
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:MCCUTCHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4602
Mailing Address - Country:US
Mailing Address - Phone:405-624-8605
Mailing Address - Fax:405-624-8606
Practice Address - Street 1:116 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4602
Practice Address - Country:US
Practice Address - Phone:405-624-8605
Practice Address - Fax:405-624-8606
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018373237700000X
OK1109237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist