Doctor Name: | PAMELA J BAGLIEN |
NPI Number: | 1982620175 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH D |
License Number: | 147 |
Business Practice Address: | 111 Lillian St Suite 101 Salmon, ID - 834674301 |
Business Phone Number: | 2087561573 |
Business Fax Number: | 2087561579 |
Mailing Address: | 111 Lillian St, Suite 101 SALMON |
State: | ID |
Postal Code: | 834674301 |
Phone Number: | 2087561573 |
Fax Number: | 2087561579 |
NPI Enumeration Date: | 07/14/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 147 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |