Individual
PAMELA WATTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1531 ROCKFORD CT, KOKOMO, IN 46902-3207
(765) 453-4500
(765) 453-4525
Mailing address
1531 ROCKFORD CT, KOKOMO, IN 46902-3207
(765) 453-4500
(765) 453-4525
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000411A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201191370A
—
IN
01
—
34000411A
LICENSE NUMBER
IN
Enumeration date
06/22/2015
Last updated
06/22/2015
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