Provider Demographics
NPI:1831466051
Name:WARD, PAMELA RAE (MS)
Entity type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:RAE
Last Name:WARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:R
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:2605 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97310-1346
Mailing Address - Country:US
Mailing Address - Phone:503-378-2438
Mailing Address - Fax:
Practice Address - Street 1:2605 STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97310-1346
Practice Address - Country:US
Practice Address - Phone:541-777-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor