Provider Demographics
NPI:1750429882
Name:REESER, PAMELA ANNE (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANNE
Last Name:REESER
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:14048 BRAMBLE BUSH CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5722
Mailing Address - Country:US
Mailing Address - Phone:407-383-7082
Mailing Address - Fax:321-400-5172
Practice Address - Street 1:14048 BRAMBLE BUSH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5722
Practice Address - Country:US
Practice Address - Phone:407-383-7082
Practice Address - Fax:321-400-5172
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 0000947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889238500Medicaid