Provider Demographics
NPI:1356664643
Name:WILEY, PAMELA SUE (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUE
Last Name:WILEY
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5761 BUCKINGHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6515
Mailing Address - Country:US
Mailing Address - Phone:310-649-6199
Mailing Address - Fax:310-649-5597
Practice Address - Street 1:5761 BUCKINGHAM PKWY
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6515
Practice Address - Country:US
Practice Address - Phone:310-649-6199
Practice Address - Fax:310-649-5597
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSP000290OtherMEDI-CAL