Provider Demographics
NPI:1487288668
Name:WHALEN, PAMELA SUE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 CLELAND RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45146-9748
Mailing Address - Country:US
Mailing Address - Phone:937-725-2052
Mailing Address - Fax:
Practice Address - Street 1:602 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2791
Practice Address - Country:US
Practice Address - Phone:937-725-2052
Practice Address - Fax:937-366-6814
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator