Healthcare Provider Details

I. General information

NPI: 1487862918
Provider Name (Legal Business Name): PAMELA H PATTON LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PARK DR SUITE 201
DOVER OH
44622-2073
US

IV. Provider business mailing address

7358 CENTRAL RD NW
STRASBURG OH
44680-9001
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-6909
  • Fax: 330-343-4883
Mailing address:
  • Phone: 330-878-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI4382
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: