Provider Demographics
NPI:1467446294
Name:MCKINLEY, PAMELA H (LISW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:H
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:H
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:158 E MARKET ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2509
Mailing Address - Country:US
Mailing Address - Phone:419-621-7333
Mailing Address - Fax:419-621-7335
Practice Address - Street 1:158 E MARKET ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2509
Practice Address - Country:US
Practice Address - Phone:419-621-7333
Practice Address - Fax:419-621-7335
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00035731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
067725OtherVALUE OPTIONS
OH000000213566OtherANTHEM BLUE CROSS