Provider Demographics
NPI:1740691823
Name:WINDER, PAMELA (BCBA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WINDER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:IL
Mailing Address - Zip Code:62898-1138
Mailing Address - Country:US
Mailing Address - Phone:618-315-6464
Mailing Address - Fax:
Practice Address - Street 1:730 E IL HIGHWAY 15
Practice Address - Street 2:UNIT 1
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-5078
Practice Address - Country:US
Practice Address - Phone:618-315-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst