Provider Demographics
NPI:1275690273
Name:HALM, PAMELA (MA, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HALM
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 1:882 KINGS POST RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3514
Mailing Address - Country:US
Mailing Address - Phone:321-632-4491
Mailing Address - Fax:
Practice Address - Street 1:882 KINGS POST RD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3514
Practice Address - Country:US
Practice Address - Phone:321-632-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist