Healthcare Provider Details

I. General information

NPI: 1285788117
Provider Name (Legal Business Name): PAMELA DALY SIBECK MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N. PARKVIEW PLACE
SURPRISE AZ
85374
US

IV. Provider business mailing address

6340 W TONOPAH DR
GLENDALE AZ
85308-6616
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax:
Mailing address:
  • Phone: 623-825-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP4850
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: