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NPI Code Detail

MEDICARE: PAMELA K RADOSEN MS

MEDICARE: PAMELA K RADOSEN MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker900WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184620684
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA K RADOSEN MS
Provider Business Mailing Address
First Line : 1900 SOUTH AVE
Second Line :
City : LA CROSSE
State : WI
Zip : 54601-5467
Country : US
Telephone Number : 608-775-2287
Fax Number :
Provider Business Practice Location Address
First Line : 123 16TH AVE S
Second Line :
City : ONALASKA
State : WI
Zip : 54650-3109
Country : US
Telephone Number : 608-775-8646
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 07/08/2007

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