Provider Demographics
NPI:1013065861
Name:KUMPF, PAMELA A (LBSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:KUMPF
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1838
Mailing Address - Country:US
Mailing Address - Phone:712-277-8991
Mailing Address - Fax:712-277-8991
Practice Address - Street 1:705 DOUGLAS ST
Practice Address - Street 2:SUITE 350
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1048
Practice Address - Country:US
Practice Address - Phone:712-277-8991
Practice Address - Fax:712-277-8991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05881101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1014746Medicaid