Provider Demographics
NPI:1396790929
Name:LUEDERS, PAMELA ANN (MSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:LUEDERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:LUEDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:3671 BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-2197
Mailing Address - Country:US
Mailing Address - Phone:916-732-8974
Mailing Address - Fax:
Practice Address - Street 1:3671 BUSINESS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-2165
Practice Address - Country:US
Practice Address - Phone:916-734-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW29457104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW 12484OtherSTATE REGISTRATION NUMBER
CAASW 25393OtherBOARD OF BEHAVIORAL SCIENCES