Provider Demographics
NPI:1881177699
Name:PALAMA, JAMIE-LYN MARIE (MS, LPC, CSAC, NBC)
Entity type:Individual
Prefix:
First Name:JAMIE-LYN
Middle Name:MARIE
Last Name:PALAMA
Suffix:
Gender:F
Credentials:MS, LPC, CSAC, NBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 S 64TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3009
Mailing Address - Country:US
Mailing Address - Phone:414-369-1106
Mailing Address - Fax:
Practice Address - Street 1:N27W23957 PAUL RD STE 101
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6223
Practice Address - Country:US
Practice Address - Phone:262-278-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6404-125101YM0800X
WI16246-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)