Active NPI
Pamela Anne Conway Breijo, M.S., CCC-SLP
- Speech-Language Pathologist
- Lodi, CA
National Provider Identifier
1982834628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP16105
- Practice address
- 1305 E Vine St
Lodi, CA 95240-3179 - Phone
- (209) 953-8000
- NPI assigned
- Jul 15, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP16105 | CA | Primary |
Addresses
Primary practice location
1305 E Vine St
Lodi, CA 95240-3179
Mailing address
1305 E Vine St
Lodi, CA 95240-3179
Phone (209) 953-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP16105 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1982834628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 E VINE ST",
"city": "LODI",
"state": "CA",
"postal_code": "952403179",
"telephone_number": "209-953-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 E VINE ST",
"city": "LODI",
"state": "CA",
"postal_code": "952403179",
"telephone_number": "209-953-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONWAY BREIJO",
"first_name": "PAMELA",
"middle_name": "ANNE",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-15",
"last_updated": "2022-07-21",
"certification_date": "2020-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "SP16105",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.