Provider Demographics
NPI:1386707560
Name:HOLLAND, PAMELA JONE (MA CCC S, BCS-S)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JONE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA CCC S, BCS-S
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:JANE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC S, BCS-S
Mailing Address - Street 1:MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Mailing Address - Street 2:1 JOHN MARSHALL DRIVE
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25755-2675
Mailing Address - Country:US
Mailing Address - Phone:304-696-3641
Mailing Address - Fax:304-696-2986
Practice Address - Street 1:MARSHALL UNIVERSITY SPEECH AND HEARING CENTER
Practice Address - Street 2:1 JOHN MARSHALL DRIVE
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-2675
Practice Address - Country:US
Practice Address - Phone:304-696-3641
Practice Address - Fax:304-696-2986
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP0533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7402191000Medicaid