MEDICARE: MS. PAMELA E GREENWAY SPEECH-LANGUAGE PATH

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	SP #630	AR

General Provider Information

NPI Number	:	1588709208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA E GREENWAY SPEECH-LANGUAGE PATH

Provider Business Mailing Address
First Line	:	405 SOUTHWEST DR
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-5856
Country	:	US
Telephone Number	:	870-219-2395
Fax Number	:	870-336-0022

Provider Business Practice Location Address
First Line	:	3423 E HIGHLAND DR STE A
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-6404
Country	:	US
Telephone Number	:	870-336-0021
Fax Number	:	870-336-0022

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/09/2007

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Directions to “ MS. PAMELA E GREENWAY SPEECH-LANGUAGE PATH” Practice Location

Language	Start Address	Practice Location

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