Healthcare Provider Details

I. General information

NPI: 1588597389
Provider Name (Legal Business Name): PAMELA VAN DER POEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2643 PIEDMONT AVE
BERKELEY CA
94704-3412
US

IV. Provider business mailing address

2020 BONAR ST
BERKELEY CA
94702-1793
US

V. Phone/Fax

Practice location:
  • Phone: 510-292-7039
  • Fax:
Mailing address:
  • Phone: 510-644-4500
  • Fax: 510-644-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: