Individual
MRS. KATHLEEN KETZLER DEMIENTIEFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
T.C., C.D.C.1
Contact information
Practice address
1027 EVERGREEN ST, FAIRBANKS, AK 99709-4306
(907) 451-8164
Mailing address
1027 EVERGREEN ST., FAIRBANKS, AK 99709-4306
(907) 451-8164
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2920
AK
101YA0400X
Addiction (Substance Use Disorder) Counselor
3432
AK
Other
Enumeration date
09/24/2008
Last updated
09/24/2008
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