Provider Demographics
NPI:1235660317
Name:PAMELA REZEK LLC
Entity Type:Organization
Organization Name:PAMELA REZEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:REZEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-630-1052
Mailing Address - Street 1:819 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1749
Mailing Address - Country:US
Mailing Address - Phone:847-630-1052
Mailing Address - Fax:
Practice Address - Street 1:819 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1749
Practice Address - Country:US
Practice Address - Phone:847-630-1052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty