Provider Demographics
NPI:1386857969
Name:GEDDES, PAMELA ELAINE (MA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ELAINE
Last Name:GEDDES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9651 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1016
Mailing Address - Country:US
Mailing Address - Phone:773-298-9629
Mailing Address - Fax:773-298-0110
Practice Address - Street 1:17504 E CARRIAGEWAY DR
Practice Address - Street 2:SUITE B
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2087
Practice Address - Country:US
Practice Address - Phone:708-799-0300
Practice Address - Fax:708-799-0300
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional