Healthcare Provider Details

I. General information

NPI: 1235178336
Provider Name (Legal Business Name): PAMELA ANNE MCCASKILL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 N MAIN ST
PLYMOUTH MI
48170-1272
US

IV. Provider business mailing address

199 N MAIN ST STE 102
PLYMOUTH MI
48170-5738
US

V. Phone/Fax

Practice location:
  • Phone: 734-416-9098
  • Fax: 734-416-0158
Mailing address:
  • Phone: 734-416-9098
  • Fax: 734-416-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301012563
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: