Provider Demographics
NPI:1265736466
Name:JOHNSEN, PAMELA JEAN (MS)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 EAST MAIN
Mailing Address - Street 2:SUITE C
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-774-7917
Mailing Address - Fax:547-774-7981
Practice Address - Street 1:1005 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7448
Practice Address - Country:US
Practice Address - Phone:541-774-7917
Practice Address - Fax:547-774-7981
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health