Provider Demographics
NPI:1215092960
Name:BINGHAM, PAULA MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:MARIE
Last Name:BINGHAM
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 1:4904 S OXBOW AVE
Mailing Address - Street 2:#103
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-4130
Mailing Address - Country:US
Mailing Address - Phone:605-361-9359
Mailing Address - Fax:
Practice Address - Street 1:500 E 54TH ST N
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0668
Practice Address - Country:US
Practice Address - Phone:605-335-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5830940Medicaid