Individual
MAM JALLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1493 MOSS CREEK AVE, ANCHORAGE, AK 99507-3800
(907) 929-5620
Mailing address
1010 W 29TH PL, ANCHORAGE, AK 99503-3744
(907) 223-0251
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
938082
AK
320700000X
Physical Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/12/2010
Last updated
02/07/2018
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