Provider Demographics
NPI:1013190123
Name:ACKLEY-FLOWERS, PAMELA J (LISW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:ACKLEY-FLOWERS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 FOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2205
Mailing Address - Country:US
Mailing Address - Phone:937-593-9600
Mailing Address - Fax:
Practice Address - Street 1:221 FOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2205
Practice Address - Country:US
Practice Address - Phone:937-593-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007178104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker