Provider Demographics
NPI:1225274327
Name:MALLETTE, PAMELA ANNE (MA, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANNE
Last Name:MALLETTE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S BATAVIA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3120
Mailing Address - Country:US
Mailing Address - Phone:630-406-6174
Mailing Address - Fax:
Practice Address - Street 1:223 S BATAVIA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-3120
Practice Address - Country:US
Practice Address - Phone:630-406-6174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-20
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.008002OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION