Provider Demographics
NPI:1801366133
Name:STANCHFIELD, PAMELA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:STANCHFIELD
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56619-0430
Mailing Address - Country:US
Mailing Address - Phone:218-444-2845
Mailing Address - Fax:218-444-2847
Practice Address - Street 1:519 ANNE ST NW STE B
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4278
Practice Address - Country:US
Practice Address - Phone:218-444-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7868OtherLICSW