Provider Demographics
NPI:1639109481
Name:CRONIN, PAMELA JEANNE (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEANNE
Last Name:CRONIN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 W 9000 S
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4775
Mailing Address - Country:US
Mailing Address - Phone:801-566-8304
Mailing Address - Fax:801-566-8330
Practice Address - Street 1:3584 W 9000 S
Practice Address - Street 2:SUITE 311
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4775
Practice Address - Country:US
Practice Address - Phone:801-566-8304
Practice Address - Fax:801-566-8330
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT107983-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT470897660008Medicaid
UT470897660008Medicaid