Provider Information for 1265286652
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PAMELA J ELY LCPC
Sex: Female
NPI: 1265286652
Last Updated: 2024-04-12
Certification Date: 2024-04-12
Certification Date: 2024-04-12
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1265286652 | ||||||||
| Enumeration Date | 2024-04-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 453 ARBORETUM WAY OSWEGO, IL 60543-8382 United States Phone: 630-479-1221 | Fax: | ||||||||
| Primary Practice Address | 453 ARBORETUM WAY OSWEGO, IL 60543-8382 United States Phone: 630-479-1221 | Fax: | ||||||||
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