Provider Demographics
NPI:1538215975
Name:HANCOCK, PAM K (SLP)
Entity type:Individual
Prefix:
First Name:PAM
Middle Name:K
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9309 W 98TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5007
Mailing Address - Country:US
Mailing Address - Phone:913-894-9150
Mailing Address - Fax:
Practice Address - Street 1:11900 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2807
Practice Address - Country:US
Practice Address - Phone:913-747-6100
Practice Address - Fax:913-747-6101
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS462235Z00000X
MO1649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist