Provider Demographics
NPI:1730497256
Name:LEDUC, PAMELA T (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:T
Last Name:LEDUC
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:T
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1083 STATE ROUTE 95
Mailing Address - Street 2:
Mailing Address - City:BOMBAY
Mailing Address - State:NY
Mailing Address - Zip Code:12914-2404
Mailing Address - Country:US
Mailing Address - Phone:518-358-0031
Mailing Address - Fax:
Practice Address - Street 1:1083 STATE ROUTE 95
Practice Address - Street 2:
Practice Address - City:BOMBAY
Practice Address - State:NY
Practice Address - Zip Code:12914-2404
Practice Address - Country:US
Practice Address - Phone:518-358-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist