Provider Demographics
NPI:1992211148
Name:WESTENDORF, PAMELA JEAN (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:WESTENDORF
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:WESTENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:1605 W 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1265
Mailing Address - Country:US
Mailing Address - Phone:319-238-2091
Mailing Address - Fax:
Practice Address - Street 1:605 E J ST STE 200
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436-1664
Practice Address - Country:US
Practice Address - Phone:641-585-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0737582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer