Provider Demographics
NPI:1790767556
Name:POLEY, PAMELA RAE (MSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RAE
Last Name:POLEY
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 1:2001 HUDSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1889
Mailing Address - Country:US
Mailing Address - Phone:269-343-9823
Mailing Address - Fax:269-345-8248
Practice Address - Street 1:2001 HUDSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1889
Practice Address - Country:US
Practice Address - Phone:269-343-9823
Practice Address - Fax:269-345-8248
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010335351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11958Medicare UPIN