Provider Demographics
NPI:1134325673
Name:SIRTAK, PAMELA A (LCPC CADC MISAII ACA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:SIRTAK
Suffix:
Gender:F
Credentials:LCPC CADC MISAII ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4563
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-4563
Mailing Address - Country:US
Mailing Address - Phone:708-715-0000
Mailing Address - Fax:
Practice Address - Street 1:284 WOODSTOCK
Practice Address - Street 2:2C
Practice Address - City:CLAREDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514
Practice Address - Country:US
Practice Address - Phone:708-715-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor