Basic Information
| Provider Information | |||||||||
| NPI: | 1083744460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOLZ | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43561 BANNOCKBURN DR | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481872819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344557409 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 26650 EUREKA RD | ||||||||
| Address2: | ST. A | ||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481804835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349553550 | ||||||||
| FaxNumber: | 7349553652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801034475 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.