Provider Demographics
NPI:1932440765
Name:SHEPARD, PAMELA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:DAHLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:270 REMINGTON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3592
Mailing Address - Country:US
Mailing Address - Phone:630-754-4522
Mailing Address - Fax:630-754-4501
Practice Address - Street 1:270 REMINGTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3592
Practice Address - Country:US
Practice Address - Phone:630-754-4522
Practice Address - Fax:630-754-4501
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490145961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical