Provider Demographics
NPI:1558559724
Name:RESENDIZ, PAMELA GRACE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:GRACE
Last Name:RESENDIZ
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 1:4706 BELAIR DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3650
Mailing Address - Country:US
Mailing Address - Phone:425-301-6679
Mailing Address - Fax:
Practice Address - Street 1:4706 BELAIR DR SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3650
Practice Address - Country:US
Practice Address - Phone:425-301-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist