Provider Demographics
NPI:1083962252
Name:GULLATT, PAMELA E (MS,CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:E
Last Name:GULLATT
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 1:221 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:DUBACH
Mailing Address - State:LA
Mailing Address - Zip Code:71235-3279
Mailing Address - Country:US
Mailing Address - Phone:318-513-1082
Mailing Address - Fax:318-513-1082
Practice Address - Street 1:221 SHENANDOAH DR
Practice Address - Street 2:
Practice Address - City:DUBACH
Practice Address - State:LA
Practice Address - Zip Code:71235-3279
Practice Address - Country:US
Practice Address - Phone:318-513-1082
Practice Address - Fax:318-513-1082
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist