Provider Demographics
NPI:1811047111
Name:MAYER, PAM D (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PAM
Middle Name:D
Last Name:MAYER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:719-660-2460
Mailing Address - Fax:
Practice Address - Street 1:2215 WOLFE RANCH RD
Practice Address - Street 2:41009 PARK DRIVE
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:719-660-2460
Practice Address - Fax:719-434-7308
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85909751Medicaid