Provider Demographics
NPI:1255999348
Name:BERN, PAMELA (MA, CCC-SLP, LLC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BERN
Suffix:
Gender:F
Credentials:MA, CCC-SLP, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-3212
Mailing Address - Country:US
Mailing Address - Phone:917-716-6552
Mailing Address - Fax:
Practice Address - Street 1:55 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-1335
Practice Address - Country:US
Practice Address - Phone:201-768-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS00394100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist