Individual
MS. ARIELLA JUANITA DERRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1427 GILLAM WAY, FAIRBANKS, AK 99701-6043
(907) 451-6682
Mailing address
1427 GILLAM WAY, FAIRBANKS, AK 99701-6043
(907) 451-6682
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000000000
—
AK
Enumeration date
09/28/2022
Last updated
09/28/2022
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