Provider Demographics
NPI:1780606129
Name:SCHMIDT-PECKHAM, PAMELA ANNE (MSW, APSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:SCHMIDT-PECKHAM
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 SUN VALLEY DR
Mailing Address - Street 2:SUITE #209
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2318
Mailing Address - Country:US
Mailing Address - Phone:262-646-8288
Mailing Address - Fax:262-646-8255
Practice Address - Street 1:2301 SUN VALLEY DR
Practice Address - Street 2:SUITE #209
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2318
Practice Address - Country:US
Practice Address - Phone:262-646-8288
Practice Address - Fax:262-646-8255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1661-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43574500Medicaid