Individual
STEPHANIE PEREAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
615 E 82ND AVE, ANCHORAGE, AK 99518-3153
(907) 222-2652
(907) 677-8777
Mailing address
615 E 82ND AVE, ANCHORAGE, AK 99518-3153
(907) 222-2652
(907) 677-8777
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CM6101
STATE OF ALASKA
AK
Enumeration date
08/27/2009
Last updated
08/27/2009
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