Provider Demographics
NPI:1992142236
Name:KNAFFLE, PAMELA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:KNAFFLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 RIGGSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-9036
Mailing Address - Country:US
Mailing Address - Phone:231-420-2506
Mailing Address - Fax:
Practice Address - Street 1:3840 RIGGSVILLE RD
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-9036
Practice Address - Country:US
Practice Address - Phone:231-420-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010911591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical