Provider Demographics
NPI:1285919191
Name:RE, PAMELA R (LPC, LCPC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:R
Last Name:RE
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2914
Mailing Address - Country:US
Mailing Address - Phone:630-980-4548
Mailing Address - Fax:
Practice Address - Street 1:121 S WILKE RD
Practice Address - Street 2:SUITE 232
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1533
Practice Address - Country:US
Practice Address - Phone:847-401-4764
Practice Address - Fax:847-749-0463
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.001019101YP2500X
IL180.009233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional