Provider Demographics
NPI:1043445299
Name:BERLIN, PAMELA SUE (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:BERLIN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 RIVERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-3807
Mailing Address - Country:US
Mailing Address - Phone:720-556-6762
Mailing Address - Fax:
Practice Address - Street 1:3037 RIVERWOOD WAY
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-3807
Practice Address - Country:US
Practice Address - Phone:720-556-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15455235Z00000X
CO0000117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist