Provider Demographics
NPI:1467768598
Name:MCNEALY, PAMELA R (MSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:R
Last Name:MCNEALY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6123 W LINCOLN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4939
Mailing Address - Country:US
Mailing Address - Phone:414-536-4206
Mailing Address - Fax:
Practice Address - Street 1:5501 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1548
Practice Address - Country:US
Practice Address - Phone:414-763-1868
Practice Address - Fax:414-763-5155
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11725-131101YA0400X
WI1673-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)