Individual
PAMELA K REYNOLDS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CADC III CC5G
Contact information
Practice address
1005 JACKSON STREET, LACROSSE, WI 54601
(608) 791-6147
(608) 791-9511
Mailing address
700 WEST AVENUE SOUTH, ATTN PHYSICIAN SERVICES, LACROSSE, WI 54601
(608) 791-4156
(608) 791-9898
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1305
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39365500
—
WI
Enumeration date
06/08/2006
Last updated
07/08/2007
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