Provider Demographics
NPI:1922185974
Name:CHASE, PAMELA JANE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:CHASE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33406 TENNESSEE RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9616
Mailing Address - Country:US
Mailing Address - Phone:661-400-0506
Mailing Address - Fax:
Practice Address - Street 1:33406 TENNESSEE RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-9616
Practice Address - Country:US
Practice Address - Phone:661-400-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 260051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical