Provider Demographics
NPI:1639630551
Name:STALTER-O'NEIL, PAMELA (LMSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:STALTER-O'NEIL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5572 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8815
Mailing Address - Country:US
Mailing Address - Phone:517-937-0243
Mailing Address - Fax:
Practice Address - Street 1:5572 VIKING DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8815
Practice Address - Country:US
Practice Address - Phone:517-937-0243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801080167104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty