Provider Demographics
NPI:1447476007
Name:HAMILTON, PAMELA K (MS, CCC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 SHENANDOAH LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2672
Mailing Address - Country:US
Mailing Address - Phone:763-416-7739
Mailing Address - Fax:
Practice Address - Street 1:3001 HARBOR LN N STE 120
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5135
Practice Address - Country:US
Practice Address - Phone:763-551-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist