Provider Demographics
NPI:1245453943
Name:SMITH, PAMELA M (SLP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 MOSS WAY
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-8274
Mailing Address - Country:US
Mailing Address - Phone:270-678-6576
Mailing Address - Fax:270-678-6576
Practice Address - Street 1:337 MOSS WAY
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-8274
Practice Address - Country:US
Practice Address - Phone:270-678-6576
Practice Address - Fax:270-678-6576
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1995235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist