Healthcare Provider Details

I. General information

NPI: 1386857969
Provider Name (Legal Business Name): PAMELA ELAINE GEDDES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17504 E CARRIAGEWAY DR SUITE B
HAZEL CREST IL
60429-2087
US

IV. Provider business mailing address

9651 S UNION AVE
CHICAGO IL
60628-1016
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-0300
  • Fax: 708-799-0300
Mailing address:
  • Phone: 773-298-9629
  • Fax: 773-298-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: