Provider Demographics
NPI:1720131089
Name:CREW, PAMELA ANN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANN
Last Name:CREW
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 1:473 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3433
Mailing Address - Country:US
Mailing Address - Phone:407-323-6955
Mailing Address - Fax:
Practice Address - Street 1:142 W LAKEVIEW AVE
Practice Address - Street 2:SUITE #2010
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2903
Practice Address - Country:US
Practice Address - Phone:407-323-6955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist