1649281676 NPI number — PATHWAYS PSYCHOLOGY ON GRAND, PLLC

Table of content: DR. PAMELA ANNE DOWELL MD (NPI 1326059239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649281676 NPI number — PATHWAYS PSYCHOLOGY ON GRAND, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWAYS PSYCHOLOGY ON GRAND, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649281676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1053 GRAND AVE
Provider Second Line Business Mailing Address:
SUITE 116
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55105-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-287-0931
Provider Business Mailing Address Fax Number:
651-287-0967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1053 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55105-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-287-0931
Provider Business Practice Location Address Fax Number:
651-287-0967
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEBLOND
Authorized Official First Name:
JILL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
HIPAA OFFICER
Authorized Official Telephone Number:
651-287-0931

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 626K2PA . This is a "BLUE CROSS BLUE SHIELD ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9374051000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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