Provider Demographics
NPI:1972186914
Name:GODETTE-MILLER, PAMELA KENNA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KENNA
Last Name:GODETTE-MILLER
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 1:663 E AUBURN FIELDS WAY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6600
Mailing Address - Country:US
Mailing Address - Phone:801-979-6146
Mailing Address - Fax:
Practice Address - Street 1:663 E AUBURN FIELDS WAY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6600
Practice Address - Country:US
Practice Address - Phone:801-979-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician