Healthcare Provider Details

I. General information

NPI: 1770414476
Provider Name (Legal Business Name): PAMELA LYNN HOUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3927 TWELVE MILE CREEK RD
MATTHEWS NC
28104-9236
US

IV. Provider business mailing address

7420 WOLF POND RD
MONROE NC
28112-7926
US

V. Phone/Fax

Practice location:
  • Phone: 704-296-6317
  • Fax:
Mailing address:
  • Phone: 704-771-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8074
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: