Provider Demographics
NPI:1487772687
Name:HINRICHS, PAMELA JO (MS)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JO
Last Name:HINRICHS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:JO
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:PO BOX
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 SHETLAND CT
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-3904
Practice Address - Country:US
Practice Address - Phone:303-517-5011
Practice Address - Fax:720-306-5246
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0000893235Z00000X
MOASHA CERT 01091600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO649046OtherANTHEM
CO9000155133Medicaid