Basic Information
| Provider Information | |||||||||
| NPI: | 1750588141 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKIVER | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 82819 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972820819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032335405 | ||||||||
| FaxNumber: | 5032332694 | ||||||||
| Practice Location | |||||||||
| Address1: | 7507 NE 51ST ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986626007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609061100 | ||||||||
| FaxNumber: | 3609061103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 06/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW60145827 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | L4523 | OR | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.