Provider Demographics
NPI:1295241743
Name:BEHRENS, PAMELA SUE (SLPA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 W DIANA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5322
Mailing Address - Country:US
Mailing Address - Phone:623-313-2551
Mailing Address - Fax:
Practice Address - Street 1:4412 W DIANA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5322
Practice Address - Country:US
Practice Address - Phone:623-313-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA70542355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant