Healthcare Provider Details

I. General information

NPI: 1417150061
Provider Name (Legal Business Name): PAMELA S WOLZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA S KINNEY LMSW

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 DEPOT ST
BELLAIRE MI
49615-9558
US

IV. Provider business mailing address

PO BOX 1166 108 DEPOT STREET
BELLAIRE MI
49615-1166
US

V. Phone/Fax

Practice location:
  • Phone: 231-350-7200
  • Fax: 231-350-7201
Mailing address:
  • Phone: 231-350-7200
  • Fax: 231-350-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085936
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: