Provider Demographics
NPI:1871801118
Name:DELASHAW, PAMELA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DELASHAW
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1129
Mailing Address - Country:US
Mailing Address - Phone:207-557-2233
Mailing Address - Fax:
Practice Address - Street 1:26 GARDEN LN
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-3048
Practice Address - Country:US
Practice Address - Phone:207-623-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP715235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist