Healthcare Provider Details

I. General information

NPI: 1114033354
Provider Name (Legal Business Name): PAMELA DENISE ST JOSEPH LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 WOODLAWN RD
STERLING IL
61081-4151
US

IV. Provider business mailing address

215 AVENUE F
ROCK FALLS IL
61071-1333
US

V. Phone/Fax

Practice location:
  • Phone: 815-625-0013
  • Fax: 815-625-0197
Mailing address:
  • Phone: 815-626-8710
  • Fax:

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: