MEDICARE: PAMELA ANN HIBBARD TIMREK M.A. 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	ASHA09125410	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09125410	OTHER		ASHA# LICENSE FOR SPEECH LANGUAGE PATHOLOGY

General Provider Information

NPI Number	:	1376786152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA ANN HIBBARD TIMREK M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	3816 LINCOLN DRIVE
Second Line	:
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48301
Country	:	US
Telephone Number	:	734-748-9345
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 LINCOLN DRIVE
Second Line	:
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48301
Country	:	US
Telephone Number	:	734-748-9345
Fax Number	:

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

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	04/09/2009

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