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General NPI Number Information
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NPI Number | 1356734784
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Entity Type | Individual
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Provider Name | PAMELA VANHESS
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Gender | Female
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 100 GOUGAR RD
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City | JOLIET
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State | IL
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Zip | 60432-9787
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Country | US
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Telephone | 815-485-8146
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Fax |
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Provider Business Mailing Address
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Address Line | 911 N RAYNOR AVE
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City | JOLIET
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State | IL
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Zip | 60435-4652
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Country | US
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Telephone | 773-320-4312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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