Provider Demographics
NPI:1063575728
Name:ANTELL, PAMELA (PH D)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:ANTELL
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E LAKE AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2037
Mailing Address - Country:US
Mailing Address - Phone:847-729-8885
Mailing Address - Fax:
Practice Address - Street 1:1701 E LAKE AVE STE 250
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2037
Practice Address - Country:US
Practice Address - Phone:847-729-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-3144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL735340Medicare ID - Type Unspecified