Provider Demographics
NPI:1336394022
Name:TALBOT, PAMELA JEAN (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:TALBOT
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VICTORY ST
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4755
Mailing Address - Country:US
Mailing Address - Phone:631-676-5769
Mailing Address - Fax:
Practice Address - Street 1:16 VICTORY ST
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4755
Practice Address - Country:US
Practice Address - Phone:631-676-5769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008357-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist