Healthcare Provider Details

I. General information

NPI: 1184752990
Provider Name (Legal Business Name): PAMELA STEPHENS-JOHNSON SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CAMINO SIERRA VISTA
SANTA FE NM
87501
US

IV. Provider business mailing address

2584 CAMINO CHUECO
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-2504
  • Fax:
Mailing address:
  • Phone: 505-310-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1420
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: