Provider Demographics
NPI:1528225521
Name:ECKENDORF, PAMELA S (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:ECKENDORF
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 ROUTE 394
Mailing Address - Street 2:
Mailing Address - City:FALCONER
Mailing Address - State:NY
Mailing Address - Zip Code:14733-9716
Mailing Address - Country:US
Mailing Address - Phone:716-661-3564
Mailing Address - Fax:
Practice Address - Street 1:1517 ROUTE 394
Practice Address - Street 2:
Practice Address - City:FALCONER
Practice Address - State:NY
Practice Address - Zip Code:14733-9716
Practice Address - Country:US
Practice Address - Phone:716-661-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003608-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist