Provider Demographics
NPI:1184756371
Name:HERTEL, PAMELA KAY (MS, LCSW, LPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:HERTEL
Suffix:
Gender:F
Credentials:MS, LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 S BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-8914
Mailing Address - Country:US
Mailing Address - Phone:920-459-9277
Mailing Address - Fax:920-459-7920
Practice Address - Street 1:5934 S BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-8914
Practice Address - Country:US
Practice Address - Phone:920-459-9277
Practice Address - Fax:920-459-7920
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2956101YM0800X
WI1939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional