Provider Demographics
NPI:1710134663
Name:FISH, PAM S (MS AUD (AUD STUDENT))
Entity Type:Individual
Prefix:MS
First Name:PAM
Middle Name:S
Last Name:FISH
Suffix:
Gender:F
Credentials:MS AUD (AUD STUDENT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13862 S SHANNAN ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9785
Mailing Address - Country:US
Mailing Address - Phone:913-888-3089
Mailing Address - Fax:913-888-3089
Practice Address - Street 1:13862 S SHANNAN ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-9785
Practice Address - Country:US
Practice Address - Phone:913-888-3089
Practice Address - Fax:913-888-3089
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS439231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist