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NPI Code Detail

MEDICARE: PAMELA LYNN MCCOLLUM LCSW

MEDICARE: PAMELA LYNN MCCOLLUM LCSW
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 Worker

General Provider Information

NPI Number : 1831253699
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA LYNN MCCOLLUM LCSW
Provider Business Mailing Address
First Line : 740 BREYS AVE NE
Second Line :
City : SALEM
State : OR
Zip : 97301-2730
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3180 CENTER ST NE
Second Line :
City : SALEM
State : OR
Zip : 97301-4532
Country : US
Telephone Number : 503-585-5351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 07/08/2007

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