Active NPI
Pamela M Banda, MSCCCSLPL
- Speech-Language Pathologist
- Willow Springs, IL
National Provider Identifier
1396892188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146001363
- Practice address
- 11767 Winding Trails Drive
Willow Springs, IL 60480-1619 - Phone
- (708) 839-9947
- Fax
- (708) 839-9947
- NPI assigned
- Jan 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146001363 | IL | Primary |
Addresses
Primary practice location
11767 Winding Trails Drive
Willow Springs, IL 60480-1619
Mailing address
11767 Winding Trails Drive
Willow Springs, IL 60480-1619
Phone (708) 839-9947
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1628161 | Other | IL | BLUE CROSS PROVIDER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146001363 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362614400000",
"number": "1396892188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11767 WINDING TRAILS DRIVE",
"city": "WILLOW SPRINGS",
"state": "IL",
"postal_code": "604801619",
"telephone_number": "708-839-9947",
"fax_number": "708-839-9947"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11767 WINDING TRAILS DRIVE",
"city": "WILLOW SPRINGS",
"state": "IL",
"postal_code": "604801619",
"telephone_number": "708-839-9947",
"fax_number": "708-839-9947"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANDA",
"first_name": "PAMELA",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "MSCCCSLPL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2013-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146001363",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER ID",
"identifier": "1628161",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Willow Springs, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.