Provider Demographics
NPI:1730966573
Name:FLEAGLE, PAMELA (MA)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:FLEAGLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10935 MISSISSIPPI DR N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3544
Mailing Address - Country:US
Mailing Address - Phone:612-581-8550
Mailing Address - Fax:
Practice Address - Street 1:10935 MISSISSIPPI DR N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3544
Practice Address - Country:US
Practice Address - Phone:612-581-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health