Healthcare Provider Details

I. General information

NPI: 1962908053
Provider Name (Legal Business Name): PAMELA ROESSLER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 E ALGONQUIN RD
ALGONQUIN IL
60102-3084
US

IV. Provider business mailing address

1190 E ALGONQUIN RD
ALGONQUIN IL
60102-3084
US

V. Phone/Fax

Practice location:
  • Phone: 847-363-0632
  • Fax:
Mailing address:
  • Phone: 847-363-0632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.013070
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: