MEDICARE: PAMELA PHELPS

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	2203000197	VA

General Provider Information

NPI Number	:	1992200992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA PHELPS

Provider Business Mailing Address
First Line	:	4 SWEET GUM PL
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-6803
Country	:	US
Telephone Number	:	757-303-7901
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E CITY HALL AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2723
Country	:	US
Telephone Number	:	757-531-3095
Fax Number	:

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	03/29/2018

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Directions to “ PAMELA PHELPS ” Practice Location

Language	Start Address	Practice Location

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