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Individual

ROXANNE PRUITT-KISER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW, LICSW

Contact information

Practice address
4060 602ND ST, BACH, FORT WAINWRIGHT, AK 99703
(073) 617-2039
Mailing address
BLDG 4060 602ND ST, FORT WAINWRIGHT, AK 99703
(907) 361-0229

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C011676
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
32055
LICSW
MN
01
C011676
LCSW
NC
Enumeration date
09/08/2018
Last updated
09/20/2023
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