Provider Demographics
NPI:1881881977
Name:INGRAM, PAMELA KAY (PSY D, LMSW, IADC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KAY
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PSY D, LMSW, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1418
Mailing Address - Country:US
Mailing Address - Phone:712-277-0809
Mailing Address - Fax:
Practice Address - Street 1:1221 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1418
Practice Address - Country:US
Practice Address - Phone:712-255-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA12109101YA0400X
103TF0200X
IA056351041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0791665Medicaid