Provider Demographics
NPI:1700131810
Name:CORDIS PONCE, PAMELA YEVETTE (LICSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:YEVETTE
Last Name:CORDIS PONCE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 CITADEL CT SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6221
Mailing Address - Country:US
Mailing Address - Phone:360-359-8311
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON ST
Practice Address - Street 2:MAMC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60152897273R00000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No273R00000XHospital UnitsPsychiatric Unit