Provider Demographics
NPI:1508173105
Name:STILES, PAMELA NICOLE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:NICOLE
Last Name:STILES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:NICOLE
Other - Last Name:POTTEBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2511 N 124TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4622
Mailing Address - Country:US
Mailing Address - Phone:262-641-4347
Mailing Address - Fax:262-641-4350
Practice Address - Street 1:2511 N 124TH ST STE 106
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4684
Practice Address - Country:US
Practice Address - Phone:262-641-4347
Practice Address - Fax:262-641-4350
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4438-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional