Provider Demographics
NPI:1770674665
Name:WHITMORE, PAMELA KLUG (MA,CCC-A)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KLUG
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2205
Mailing Address - Country:US
Mailing Address - Phone:304-469-6819
Mailing Address - Fax:304-253-9470
Practice Address - Street 1:218 RAGLAND RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9721
Practice Address - Country:US
Practice Address - Phone:304-252-0790
Practice Address - Fax:304-253-9470
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA0054231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV151726500OtherDEPT OF LABOR
WV001711216OtherBLUE CROSS BLUE SHIELD
WV640004323OtherRAILROAD MEDICARE
WV3401020000Medicaid
WV1770674665Medicare NSC