Provider Demographics
NPI:1619457520
Name:RANGEL, PAMELA SUE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:RANGEL
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 1:7627 BARTELL PT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6070
Mailing Address - Country:US
Mailing Address - Phone:210-287-6323
Mailing Address - Fax:
Practice Address - Street 1:4211 GARDENDALE ST STE 200A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3529
Practice Address - Country:US
Practice Address - Phone:210-287-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist