Provider Demographics
NPI:1568750511
Name:MILLER, PAMELA SUE (MSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUE
Last Name:MILLER
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 1:4715 BENNETT RD APT 13
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2544
Mailing Address - Country:US
Mailing Address - Phone:419-917-5683
Mailing Address - Fax:
Practice Address - Street 1:2109 HUGHES DR STE 640
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5107
Practice Address - Country:US
Practice Address - Phone:419-291-8892
Practice Address - Fax:419-291-6436
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0600678104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker