Provider Demographics
NPI:1073821476
Name:JURON, PAMELA RACHELLE (MS, SLP/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RACHELLE
Last Name:JURON
Suffix:
Gender:F
Credentials:MS, SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 GARROCK RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4189
Mailing Address - Country:US
Mailing Address - Phone:716-689-6813
Mailing Address - Fax:
Practice Address - Street 1:130 BEATTIE AVENUE
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-478-4808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008285-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist