Provider Demographics
NPI:1265146989
Name:JUNGMAN, PAMELA A
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:JUNGMAN
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 1:330 TOLBERT ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1237
Mailing Address - Country:US
Mailing Address - Phone:440-666-8648
Mailing Address - Fax:
Practice Address - Street 1:330 TOLBERT ST
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1237
Practice Address - Country:US
Practice Address - Phone:440-666-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services