Provider Demographics
NPI:1134390503
Name:HEWITT-MEYER, PAMELA CONSTANCE (PSYD, LCP, LCPC)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:CONSTANCE
Last Name:HEWITT-MEYER
Suffix:
Gender:F
Credentials:PSYD, LCP, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-0085
Mailing Address - Country:US
Mailing Address - Phone:217-322-2575
Mailing Address - Fax:217-322-2574
Practice Address - Street 1:338 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1324
Practice Address - Country:US
Practice Address - Phone:217-322-2575
Practice Address - Fax:217-322-2574
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007817103TA0700X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent