Provider Demographics
NPI:1790453355
Name:WINNICKI, PAMELA GAIL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:GAIL
Last Name:WINNICKI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 THOMAS RUN RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1600
Mailing Address - Country:US
Mailing Address - Phone:410-638-3810
Mailing Address - Fax:
Practice Address - Street 1:100 THOMAS RUN RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-1600
Practice Address - Country:US
Practice Address - Phone:410-638-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist