Provider Demographics
NPI:1053594473
Name:MAYTON, PAMELA SUE (MSCCCSLP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:MAYTON
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3856 CHARBON LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2077
Mailing Address - Country:US
Mailing Address - Phone:901-371-0139
Mailing Address - Fax:
Practice Address - Street 1:3856 CHARBON LN
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2077
Practice Address - Country:US
Practice Address - Phone:901-371-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist