Provider Demographics
NPI:1356482533
Name:VREDEVELT, PAMELA WALKER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:WALKER
Last Name:VREDEVELT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 SW WALTERS LOOP
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-5322
Mailing Address - Country:US
Mailing Address - Phone:503-661-7733
Mailing Address - Fax:503-661-7890
Practice Address - Street 1:333 SE 223RD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7454
Practice Address - Country:US
Practice Address - Phone:503-661-7733
Practice Address - Fax:503-661-7890
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLPC CO280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional