Provider Demographics
NPI:1649596685
Name:BUCKLEY, PAMELA CHARLIE MARIE
Entity Type:Individual
Prefix:
First Name:PAMELA CHARLIE
Middle Name:MARIE
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3588 E. HWY 60
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537
Mailing Address - Country:US
Mailing Address - Phone:970-667-4883
Mailing Address - Fax:970-667-0034
Practice Address - Street 1:3588 E HWY 60
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537
Practice Address - Country:US
Practice Address - Phone:970-667-4883
Practice Address - Fax:970-667-0034
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01085069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist