Provider Demographics
NPI:1073836441
Name:GERDES, PAMELA PATRICIA (LISW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:PATRICIA
Last Name:GERDES
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 1:6583 CARRIAGE HILL LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2450
Mailing Address - Country:US
Mailing Address - Phone:513-659-4852
Mailing Address - Fax:513-451-2407
Practice Address - Street 1:7577 CENTRAL PARKE BLVD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6810
Practice Address - Country:US
Practice Address - Phone:513-770-3231
Practice Address - Fax:513-770-5541
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI09002541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical