MEDICARE: PAMELA H. BASHOR CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	125	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0264N	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1225261209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA H. BASHOR CCC-SLP

Provider Business Mailing Address
First Line	:	320 LILLINGTON AVE
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3188
Country	:	US
Telephone Number	:	704-375-5231
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 LILLINGTON AVE
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3188
Country	:	US
Telephone Number	:	704-375-5231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	09/17/2009

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