Provider Demographics
NPI:1992898001
Name:WRIGHT-HACHET, PAMELA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:WRIGHT-HACHET
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 1:1870 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5650
Mailing Address - Country:US
Mailing Address - Phone:616-956-9619
Mailing Address - Fax:616-956-8033
Practice Address - Street 1:1870 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5650
Practice Address - Country:US
Practice Address - Phone:616-956-9619
Practice Address - Fax:616-956-8033
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081249104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800D162220OtherBC/BS
MID16222121Medicare ID - Type UnspecifiedMEDICARE
MI800D162220OtherBC/BS