Individual
BRIAN AHLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
381 4TH AVENUE, BETHEL, AK 99559-0528
(907) 543-2242
(907) 543-1481
Mailing address
PO BOX 3227, BETHEL, AK 99559-3227
(907) 543-2242
(907) 543-1481
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020986
—
AK
Enumeration date
04/21/2016
Last updated
12/26/2018
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