Provider Demographics
NPI:1750654174
Name:COATS, PAMELA ERIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ERIN
Last Name:COATS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:IL
Mailing Address - Zip Code:62691-1571
Mailing Address - Country:US
Mailing Address - Phone:217-322-4373
Mailing Address - Fax:217-322-2138
Practice Address - Street 1:8590 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618-8398
Practice Address - Country:US
Practice Address - Phone:217-323-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490161631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical