Individual
IVY KATHERINE RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
460 RIDGECREST DRIVE, SUITE 215, BETHEL, AK 99559
(907) 543-2762
(907) 543-3152
Mailing address
PO BOX 528, ATTN: BH DD SERVICES, BETHEL, AK 99559-0528
(907) 543-2762
(907) 543-3152
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002447
—
AK
Enumeration date
08/17/2015
Last updated
03/09/2018
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