Provider Demographics
NPI:1831386051
Name:LAGUE, PAMELA S (LSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:LAGUE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:S
Other - Last Name:WOCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:285 BIELBY RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1055
Mailing Address - Country:US
Mailing Address - Phone:812-537-1302
Mailing Address - Fax:812-537-5219
Practice Address - Street 1:285 BIELBY RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1055
Practice Address - Country:US
Practice Address - Phone:812-537-1302
Practice Address - Fax:812-537-5219
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33004969A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33004969AOtherSTATE LICENSE NUMBER