Provider Demographics
NPI:1619037934
Name:RITT, PAMELLA R (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:PAMELLA
Middle Name:R
Last Name:RITT
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BREEZEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8903
Mailing Address - Country:US
Mailing Address - Phone:919-751-1468
Mailing Address - Fax:919-751-1468
Practice Address - Street 1:201 BREEZEWOOD DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8903
Practice Address - Country:US
Practice Address - Phone:919-751-1468
Practice Address - Fax:919-751-1468
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411121Medicaid