Provider Demographics
NPI:1063643310
Name:CAMPELLONE, PAMELA JEAN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:CAMPELLONE
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 1:71 MESSENGER ST
Mailing Address - Street 2:APT. 821
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2230
Mailing Address - Country:US
Mailing Address - Phone:401-486-6717
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN ST
Practice Address - Street 2:EASTER SEALS MASSACHUSETTS
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1893
Practice Address - Country:US
Practice Address - Phone:800-244-2756
Practice Address - Fax:508-831-9768
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01018235Z00000X
MA7677235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist