Provider Demographics
NPI:1740630508
Name:LIEBENTHAL BAKER, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LIEBENTHAL BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 ETIWANDA AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6145
Mailing Address - Country:US
Mailing Address - Phone:818-345-3200
Mailing Address - Fax:818-345-3254
Practice Address - Street 1:5525 ETIWANDA AVE STE 309
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6145
Practice Address - Country:US
Practice Address - Phone:818-345-3200
Practice Address - Fax:818-345-3254
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAD8104237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist