Provider Demographics
NPI:1447075411
Name:PANKOW, DENISE ELLEN
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ELLEN
Last Name:PANKOW
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 1:191 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5918
Mailing Address - Country:US
Mailing Address - Phone:301-676-5891
Mailing Address - Fax:
Practice Address - Street 1:191 S EAST ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5918
Practice Address - Country:US
Practice Address - Phone:240-586-8829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool