Provider Demographics
NPI:1952777864
Name:BARNES, PAMELA KAY (MHS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:BARNES
Suffix:
Gender:F
Credentials:MHS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68784-5014
Mailing Address - Country:US
Mailing Address - Phone:402-287-2061
Mailing Address - Fax:402-287-2065
Practice Address - Street 1:211 10TH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:NE
Practice Address - Zip Code:68784-5014
Practice Address - Country:US
Practice Address - Phone:402-287-2061
Practice Address - Fax:402-287-2065
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2011005821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE235Z00000XOtherNEBRASKA DEPARTMENT OF EDUCATION/TEACHER CERTIFICATION
09127998OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION/CERTIFICATION