Provider Demographics
NPI:1922084565
Name:BROCK, PAMELA LYN (MS)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LYN
Last Name:BROCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:LYN
Other - Last Name:FARNSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2012 KENNY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3502
Mailing Address - Country:US
Mailing Address - Phone:614-293-3147
Mailing Address - Fax:614-293-2314
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-3147
Practice Address - Fax:614-293-2314
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
OH000207170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS