Provider Demographics
NPI:1679076830
Name:BLOCH, PAMELA FLEURETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:FLEURETTE
Last Name:BLOCH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2330
Mailing Address - Country:US
Mailing Address - Phone:510-599-2252
Mailing Address - Fax:
Practice Address - Street 1:2021 YGNACIO VALLEY RD STE C202
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3392
Practice Address - Country:US
Practice Address - Phone:925-945-1474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist