Provider Demographics
NPI:1457702912
Name:MIDDLETON, PAMELA M (LSCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:LEIKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:1819 11TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4511
Mailing Address - Country:US
Mailing Address - Phone:785-483-9183
Mailing Address - Fax:
Practice Address - Street 1:1819 11TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4511
Practice Address - Country:US
Practice Address - Phone:785-483-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5153104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker