Provider Demographics
NPI:1841625035
Name:STOVER, PAMELA VILETTA (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:VILETTA
Last Name:STOVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:KOUTS
Mailing Address - State:IN
Mailing Address - Zip Code:46347-0166
Mailing Address - Country:US
Mailing Address - Phone:219-281-6163
Mailing Address - Fax:219-386-3600
Practice Address - Street 1:1740 E 67 N
Practice Address - Street 2:LOT 57 B
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750
Practice Address - Country:US
Practice Address - Phone:219-386-3600
Practice Address - Fax:219-386-3660
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX577981041C0700X
IN34007467A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300045162Medicaid