Individual
JIL DIANE BOTTRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
600 UNIVERSITY AVE, FAIRBANKS, AK 99709-3643
(907) 457-4177
Mailing address
4054 TEAL AVE, FAIRBANKS, AK 99709-3520
(907) 479-4177
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
176
AK
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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