Provider Demographics
NPI:1144401175
Name:HAVENS, PAMELA KAY (LSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:HAVENS
Suffix:
Gender:F
Credentials:LSW
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 322
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-0322
Mailing Address - Country:US
Mailing Address - Phone:815-432-5241
Mailing Address - Fax:815-432-4537
Practice Address - Street 1:323 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1568
Practice Address - Country:US
Practice Address - Phone:815-432-5241
Practice Address - Fax:815-432-4537
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker