Basic Information
| Provider Information | |||||||||
| NPI: | 1487029302 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLAN | ||||||||
| FirstName: | PAMELA | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12010 CALDWALLER RD | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484308418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106298876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12319 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | HARTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483532946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109911211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2015 | ||||||||
| LastUpdateDate: | 12/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101000843 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.