Provider Demographics
NPI:1245699602
Name:JAMISON, PAMELA (ME/CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:ME/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 WILDFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-3243
Mailing Address - Country:US
Mailing Address - Phone:801-473-3046
Mailing Address - Fax:
Practice Address - Street 1:1072 WILDFLOWER WAY
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663
Practice Address - Country:US
Practice Address - Phone:385-314-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT65170954102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist