Healthcare Provider Details

I. General information

NPI: 1134390503
Provider Name (Legal Business Name): PAMELA CONSTANCE HEWITT-MEYER PSYD, LCP, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 W LAFAYETTE ST
RUSHVILLE IL
62681-1324
US

IV. Provider business mailing address

PO BOX 85
RUSHVILLE IL
62681-0085
US

V. Phone/Fax

Practice location:
  • Phone: 217-322-2575
  • Fax: 217-322-2574
Mailing address:
  • Phone: 217-322-2575
  • Fax: 217-322-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number071.007817
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.007817
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number071.007817
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: