Provider Demographics
NPI:1588271837
Name:HOAG, PAMELA J (SLP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:HOAG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:COUNCILMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 LAMSON AVE
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9710
Mailing Address - Country:US
Mailing Address - Phone:413-883-6306
Mailing Address - Fax:
Practice Address - Street 1:30 LAMSON AVE
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9710
Practice Address - Country:US
Practice Address - Phone:413-883-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty