Organization
PTARMIGAN CONNECTIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBI S KOUSOULOS (PRACTICE ADMINISTRATOR)
(907) 357-4543
Entity
Organization
Contact information
Practice address
3505 E MERIDIAN PARK LOOP, SUITE 200, WASILLA, AK 99654
(907) 357-4543
Mailing address
3543 E MERIDIAN PARK LOOP STE A, WASILLA, AK 99654-7294
(907) 357-4543
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103G00000X
Clinical Neuropsychologist
—
—
208000000X
Pediatrics Physician
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
06/20/2017
Last updated
06/20/2017
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