Provider Demographics
NPI:1164773867
Name:KANEHANN, PAMELA ADELE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ADELE
Last Name:KANEHANN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31000 TELEGRAPH RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4360
Mailing Address - Country:US
Mailing Address - Phone:248-877-0054
Mailing Address - Fax:
Practice Address - Street 1:31000 TELEGRAPH RD
Practice Address - Street 2:SUITE 130
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4360
Practice Address - Country:US
Practice Address - Phone:248-877-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010715931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical