Provider Demographics
NPI:1144856220
Name:KUNKEL-CHAPPELL, PAMELA J
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:KUNKEL-CHAPPELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 KINNEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ONONDAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49264-9765
Mailing Address - Country:US
Mailing Address - Phone:517-812-4628
Mailing Address - Fax:
Practice Address - Street 1:4480 KINNEVILLE RD
Practice Address - Street 2:
Practice Address - City:ONONDAGA
Practice Address - State:MI
Practice Address - Zip Code:49264-9765
Practice Address - Country:US
Practice Address - Phone:517-812-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional