Provider Demographics
NPI:1306173497
Name:MILLIGAN, PAMOLEE RUSSELL (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PAMOLEE
Middle Name:RUSSELL
Last Name:MILLIGAN
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 1:100 ROBERT H. FISER DR.
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4517
Mailing Address - Country:US
Mailing Address - Phone:501-354-1170
Mailing Address - Fax:
Practice Address - Street 1:100 ROBERT H. FISER DR.
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4517
Practice Address - Country:US
Practice Address - Phone:501-354-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1431235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist