MEDICARE: PAMELA I IJEH CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	105280	TX

General Provider Information

NPI Number	:	1518268754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA I IJEH CCC-SLP

Provider Business Mailing Address
First Line	:	1820 S MASON RD STE 350
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-3248
Country	:	US
Telephone Number	:	713-471-9086
Fax Number	:	832-554-9973

Provider Business Practice Location Address
First Line	:	7830 W GRAND PKWY S STE 270
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5818
Country	:	US
Telephone Number	:	713-471-9086
Fax Number	:	832-554-9973

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	10/09/2020

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Directions to “ PAMELA I IJEH CCC-SLP” Practice Location

Language	Start Address	Practice Location

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