Provider Demographics
NPI:1750409009
Name:HAUKE, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HAUKE
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 1:730 SHERIDAN RD APT 203
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-1181
Mailing Address - Country:US
Mailing Address - Phone:262-914-0507
Mailing Address - Fax:
Practice Address - Street 1:6232 BANKERS RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9747
Practice Address - Country:US
Practice Address - Phone:262-583-0137
Practice Address - Fax:262-583-0097
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12150101YA0400X
WI7187-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11013500Medicaid
WI11013500Medicaid