Provider Demographics
NPI:1447232327
Name:MINDT, PAMELA SUE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUE
Last Name:MINDT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8389 SW 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3903
Mailing Address - Country:US
Mailing Address - Phone:503-452-2445
Mailing Address - Fax:
Practice Address - Street 1:1115 SW 11TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2006
Practice Address - Country:US
Practice Address - Phone:503-988-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL32461041C0700X
HI14601041C0700X
WALW000079171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical