Provider Demographics
NPI:1811018518
Name:PADFIELD, PAMALA
Entity Type:Individual
Prefix:
First Name:PAMALA
Middle Name:
Last Name:PADFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62293-1611
Mailing Address - Country:US
Mailing Address - Phone:618-224-9908
Mailing Address - Fax:618-224-9908
Practice Address - Street 1:107 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:IL
Practice Address - Zip Code:62293-1611
Practice Address - Country:US
Practice Address - Phone:618-224-9908
Practice Address - Fax:618-224-9908
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
IL2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Not Answered2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant