Provider Demographics
NPI:1457098931
Name:GUTIERREZ, PAMELA DANIELLE BOLUS (MS, CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA DANIELLE
Middle Name:BOLUS
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 TABERNASH
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3743
Mailing Address - Country:US
Mailing Address - Phone:972-675-3150
Mailing Address - Fax:
Practice Address - Street 1:3114 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-5824
Practice Address - Country:US
Practice Address - Phone:972-675-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist