Provider Demographics
NPI:1073934899
Name:METZGER, PAMELA JO (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:JO
Last Name:METZGER
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 1:20770 DONIELLE CT
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7750
Mailing Address - Country:US
Mailing Address - Phone:951-609-9720
Mailing Address - Fax:
Practice Address - Street 1:20770 DONIELLE CT
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7750
Practice Address - Country:US
Practice Address - Phone:951-609-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP10851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist