Provider Demographics
NPI:1588407043
Name:BENTLEY, PAMELA INA (MS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:INA
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 NEW OAK TRL
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4043
Mailing Address - Country:US
Mailing Address - Phone:281-450-9887
Mailing Address - Fax:
Practice Address - Street 1:2665 ROYAL FRST STE B-90
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5045
Practice Address - Country:US
Practice Address - Phone:281-358-0577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist