Provider Demographics
NPI:1871617480
Name:COWAN, PAMELA R (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:R
Last Name:COWAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BIG POND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CROSS ROADS
Mailing Address - State:PA
Mailing Address - Zip Code:16914-7820
Mailing Address - Country:US
Mailing Address - Phone:570-596-4826
Mailing Address - Fax:
Practice Address - Street 1:15900 ROUTE 6
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-9308
Practice Address - Country:US
Practice Address - Phone:570-297-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000782235Z00000X
PASL004482L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist