Provider Demographics
NPI:1952331597
Name:COUNSELL, PAMELA S
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:COUNSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17904 157TH PL SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1706
Mailing Address - Country:US
Mailing Address - Phone:360-794-3688
Mailing Address - Fax:
Practice Address - Street 1:17788 147TH ST SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1030
Practice Address - Country:US
Practice Address - Phone:360-794-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00013204183700000X
WAC19724225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183700000XPharmacy Service ProvidersPharmacy Technician
Not Answered225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVA00013204OtherPHARMACY TECHNICIAN
WAC19724OtherBOC ORTHOTIC FITTER