Individual
PAMELA WINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6110 HOWDERSHELL RD, HAZELWOOD, MO 63042-1170
(314) 942-9499
Mailing address
4166 LINDELL BLVD STE 1B, SAINT LOUIS, MO 63108-2923
(314) 484-7758
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
164W00000X
Licensed Practical Nurse
Primary
2009031393
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500075300
—
MO
Enumeration date
09/27/2019
Last updated
09/27/2019
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