Provider Demographics
NPI:1023024106
Name:BURGESS, PAMELA B (AUDIOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:B
Last Name:BURGESS
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:B
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUDIOLOGIST
Mailing Address - Street 1:2125 S BROADWAY STE 111
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7835
Mailing Address - Country:US
Mailing Address - Phone:805-922-2884
Mailing Address - Fax:805-922-2844
Practice Address - Street 1:2125 S BROADWAY STE 111
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7835
Practice Address - Country:US
Practice Address - Phone:805-922-2884
Practice Address - Fax:805-922-2844
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADAU3118237700000X
CAAU3118231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist