Provider Demographics
NPI:1659882702
Name:PYLE, PAMELA MAE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MAE
Last Name:PYLE
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 1:13440 N 44TH ST APT 1150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6393
Mailing Address - Country:US
Mailing Address - Phone:970-250-1525
Mailing Address - Fax:
Practice Address - Street 1:13440 N 44TH ST APT 1150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6393
Practice Address - Country:US
Practice Address - Phone:970-250-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10892235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist