Provider Demographics
NPI:1245611813
Name:SCHMITT, PAM (BCC,LADC)
Entity Type:Individual
Prefix:MRS
First Name:PAM
Middle Name:
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:BCC,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11177 PANAMA AVE S
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-9156
Mailing Address - Country:US
Mailing Address - Phone:651-558-1838
Mailing Address - Fax:
Practice Address - Street 1:11177 PANAMA AVE S
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-9156
Practice Address - Country:US
Practice Address - Phone:651-558-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301850101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)