Provider Demographics
NPI:1891122073
Name:HEISLER, PAMELA LYNN
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LYNN
Last Name:HEISLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:LYNN
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96087-0648
Mailing Address - Country:US
Mailing Address - Phone:530-378-1855
Mailing Address - Fax:530-378-0857
Practice Address - Street 1:855 CANYON RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-5544
Practice Address - Country:US
Practice Address - Phone:530-378-1855
Practice Address - Fax:530-378-0857
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01723411Medicare PIN