Provider Demographics
NPI:1316086572
Name:CALLIA, PAMELA JANE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:CALLIA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 SHANNON CIR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3122
Mailing Address - Country:US
Mailing Address - Phone:830-620-1521
Mailing Address - Fax:
Practice Address - Street 1:14207 HIGGINS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1252
Practice Address - Country:US
Practice Address - Phone:210-846-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149343901Medicaid