Provider Demographics
NPI:1588732887
Name:WESCOTT, PAMELA SUE (MA)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:WESCOTT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 LAKEVIEW TERRACE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7721
Mailing Address - Country:US
Mailing Address - Phone:907-456-4599
Mailing Address - Fax:907-456-4597
Practice Address - Street 1:3504 INDUSTRIAL AVE
Practice Address - Street 2:#105
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7390
Practice Address - Country:US
Practice Address - Phone:907-456-4599
Practice Address - Fax:907-456-4597
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK029504103T00000X
CO4326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist