Provider Demographics
NPI:1982859062
Name:RYAN, PAMELA LYNN (M A)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:LYNN
Last Name:RYAN
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 COURT ST
Mailing Address - Street 2:APT. 4
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2742
Mailing Address - Country:US
Mailing Address - Phone:518-369-2186
Mailing Address - Fax:
Practice Address - Street 1:427 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1707
Practice Address - Country:US
Practice Address - Phone:518-561-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017319-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist