Provider Demographics
NPI:1316065634
Name:BARRY, PAMELA JEANNE (CCC-SLP, CCC-A)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEANNE
Last Name:BARRY
Suffix:
Gender:F
Credentials:CCC-SLP, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 W ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-8320
Mailing Address - Country:US
Mailing Address - Phone:208-466-3260
Mailing Address - Fax:
Practice Address - Street 1:619 S CANYON ST
Practice Address - Street 2:NAMPA SCHOOL DISTRICT
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6634
Practice Address - Country:US
Practice Address - Phone:208-468-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-1194231H00000X
IDSLP-1194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist