Provider Demographics
NPI:1235526344
Name:WON, PAMELA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WON
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 1:2817 WISTERIA LN
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4957
Mailing Address - Country:US
Mailing Address - Phone:909-203-2700
Mailing Address - Fax:
Practice Address - Street 1:2817 WISTERIA LN
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4957
Practice Address - Country:US
Practice Address - Phone:909-203-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist