Pamela Michelle Crecca, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4744 Issued in NC

Practice address

1936 Opitz Blvd Ste a
Woodbridge, VA 22191-3360

Phone

(703) 543-9164

NPI assigned

Dec 9, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Pamela Michelle Crecca Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1205104957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 542",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225550542",
            "telephone_number": "252-571-1419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1936 OPITZ BLVD STE A",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913360",
            "telephone_number": "703-543-9164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRECCA",
        "first_name": "PAMELA",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-09",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "4744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7411490",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAMELA",
            "last_name": "CRECCA",
            "middle_name": "MICHELLE",
            "prefix": "MRS.",
            "credential": "M.S., CCC-SLP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Speech-Language Pathologist in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.