Provider Demographics
NPI:1851846216
Name:TASSIELLO, PAMELA B (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:B
Last Name:TASSIELLO
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:B
Other - Last Name:KALISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:11 HEDGE MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1320
Mailing Address - Country:US
Mailing Address - Phone:203-803-0561
Mailing Address - Fax:
Practice Address - Street 1:11 HEDGE MEADOW LN
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1320
Practice Address - Country:US
Practice Address - Phone:203-803-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-354204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist