Provider Demographics
NPI:1881215804
Name:BRAZELTON-SYKES, PAMELA ANN (MA, MS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:BRAZELTON-SYKES
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 E 53RD ST # 911
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4573
Mailing Address - Country:US
Mailing Address - Phone:708-420-0225
Mailing Address - Fax:773-420-3597
Practice Address - Street 1:PIONEER GARDENS SUPPORTIVE LIVING
Practice Address - Street 2:3800 S KING DR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653
Practice Address - Country:US
Practice Address - Phone:773-420-3481
Practice Address - Fax:773-420-3597
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor