Provider Demographics
NPI:1790996684
Name:VANDENAKER, PAMELA WILSON (MS)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:WILSON
Last Name:VANDENAKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 S 1300 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3580
Mailing Address - Country:US
Mailing Address - Phone:801-785-9400
Mailing Address - Fax:801-785-9499
Practice Address - Street 1:145 S 1300 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3580
Practice Address - Country:US
Practice Address - Phone:801-785-9400
Practice Address - Fax:801-785-9499
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT973368026004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional