Provider Demographics
NPI:1598984304
Name:MINARD, PAMELA KIM (AUD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:KIM
Last Name:MINARD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OHIO HEALTH BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8900
Mailing Address - Country:US
Mailing Address - Phone:740-368-5588
Mailing Address - Fax:740-368-5590
Practice Address - Street 1:801 OHIO HEALTH BLVD
Practice Address - Street 2:STE 220
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8900
Practice Address - Country:US
Practice Address - Phone:740-368-5588
Practice Address - Fax:740-368-5590
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00842231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA00842OtherAUDIOLOGY LICENSE
0836953Medicare PIN