Individual
JACQUELINE TILLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9441 KYLIE CIR, ANCHORAGE, AK 99502-1448
(919) 808-7163
Mailing address
9441 KYLIE CIR, ANCHORAGE, AK 99502-1448
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
03/10/2022
Last updated
05/02/2022
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