Provider Demographics
NPI:1497889190
Name:GALLIEN, PAM (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:GALLIEN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1809 INDIAN WELLS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4617
Mailing Address - Country:US
Mailing Address - Phone:505-437-1967
Mailing Address - Fax:505-437-3969
Practice Address - Street 1:1809 INDIAN WELLS RD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4617
Practice Address - Country:US
Practice Address - Phone:505-437-1967
Practice Address - Fax:505-437-3969
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM269173YNS4Medicare UPIN