Provider Demographics
NPI:1538417670
Name:ABRAHAMSEN, PAMELA (MS, LPC-IT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ABRAHAMSEN
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 ANNEX RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9803
Mailing Address - Country:US
Mailing Address - Phone:992-674-3105
Mailing Address - Fax:920-674-2359
Practice Address - Street 1:20 SHERMAN AVE E
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1864
Practice Address - Country:US
Practice Address - Phone:920-728-1810
Practice Address - Fax:877-391-0643
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3541-226101YP2500X
WI8190-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional