Provider Demographics
NPI:1871688606
Name:HILLIARD-DAVIS, PAMELA J (MS, CCC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:HILLIARD-DAVIS
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:535 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14706
Mailing Address - Country:US
Mailing Address - Phone:716-376-2216
Mailing Address - Fax:716-373-6632
Practice Address - Street 1:535 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14706
Practice Address - Country:US
Practice Address - Phone:716-376-2216
Practice Address - Fax:716-373-6632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005277235Z00000X
NY005277-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist