Provider Demographics
NPI:1659511004
Name:REYNOLDS-KLOCKE, PAMELA LYNN
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:REYNOLDS-KLOCKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LYNN
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7380 FRANCE AVE S STE 200
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4506
Mailing Address - Country:US
Mailing Address - Phone:952-831-4222
Mailing Address - Fax:952-831-4942
Practice Address - Street 1:14050 NICOLLET AVE STE 200
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5738
Practice Address - Country:US
Practice Address - Phone:952-303-5895
Practice Address - Fax:952-303-6062
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7959237600000X, 231H00000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter