Provider Demographics
NPI:1659328128
Name:GJERTSON, PAMELA S (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:GJERTSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 SOUTH FWY STE 209
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7214
Mailing Address - Country:US
Mailing Address - Phone:682-385-7010
Mailing Address - Fax:682-385-7011
Practice Address - Street 1:12001 SOUTH FWY STE 209
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7214
Practice Address - Country:US
Practice Address - Phone:823-857-0106
Practice Address - Fax:682-385-7011
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA8540237600000X
231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter