Individual
TAMARA O STADEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
1700 BOGARD RD, SUITE 201, WASILLA, AK 99654-6533
(907) 373-8080
(907) 373-8081
Mailing address
1700 BOGARD RD, SUITE 201, WASILLA, AK 99654-6533
(907) 373-8080
(907) 373-8081
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
50
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH4828
—
AK
Enumeration date
07/12/2006
Last updated
07/08/2007
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