Provider Demographics
NPI:1154783058
Name:GREMMELS, PAMELA (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GREMMELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W WASHINGTON ST
Mailing Address - Street 2:2A
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-1667
Mailing Address - Country:US
Mailing Address - Phone:217-369-0335
Mailing Address - Fax:
Practice Address - Street 1:112 W WASHINGTON ST
Practice Address - Street 2:2A
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-1667
Practice Address - Country:US
Practice Address - Phone:217-369-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0032371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical