Provider Demographics
NPI:1639240500
Name:EVERETT, PAMELA JOYCE (MA, CCC, SP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JOYCE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MA, CCC, SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 W HAMILTON RD S
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9414
Mailing Address - Country:US
Mailing Address - Phone:260-625-4450
Mailing Address - Fax:
Practice Address - Street 1:4824 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-5461
Practice Address - Country:US
Practice Address - Phone:260-431-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist