Provider Demographics
NPI:1609386481
Name:HALL, PAMELA (MS QMHP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MS QMHP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:STREUTER-WIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1660
Mailing Address - Country:US
Mailing Address - Phone:619-658-2611
Mailing Address - Fax:
Practice Address - Street 1:101 OLIVER ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1660
Practice Address - Country:US
Practice Address - Phone:619-658-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health