Provider Demographics
NPI:1245544089
Name:GODSOE, PAMELA S (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:GODSOE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2945
Mailing Address - Country:US
Mailing Address - Phone:508-397-0883
Mailing Address - Fax:
Practice Address - Street 1:5 N MEADOWS RD
Practice Address - Street 2:SPEECH-LANGUAGE & HEARING ASSOCIATES, PC
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2317
Practice Address - Country:US
Practice Address - Phone:508-359-4532
Practice Address - Fax:508-359-0198
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21875OtherMEDICARE PTAN