Provider Demographics
NPI:1396992152
Name:POWELL, PAMELA WRIGHT (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:WRIGHT
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 RIDGE WATER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-3044
Mailing Address - Country:US
Mailing Address - Phone:865-379-9366
Mailing Address - Fax:
Practice Address - Street 1:4262 RIDGE WATER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-3044
Practice Address - Country:US
Practice Address - Phone:865-679-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist