Provider Demographics
NPI:1063631026
Name:BURD, PAMELA G (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:G
Last Name:BURD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10530 E OAK CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:CORNVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86325-5821
Mailing Address - Country:US
Mailing Address - Phone:928-301-0663
Mailing Address - Fax:
Practice Address - Street 1:535 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3902
Practice Address - Country:US
Practice Address - Phone:928-639-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist