Provider Demographics
NPI:1548626989
Name:GRESKOWIAK, PAMELA KAY (LCPC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAY
Last Name:GRESKOWIAK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 5TH ST E STE 101
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4970
Mailing Address - Country:US
Mailing Address - Phone:406-257-1206
Mailing Address - Fax:833-623-4164
Practice Address - Street 1:30 5TH ST E STE 101
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4970
Practice Address - Country:US
Practice Address - Phone:406-257-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7292082Medicaid