Individual
JENNIFER WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1717 W COWLES ST, FAIRBANKS, AK 99701-5926
(907) 451-6682
Mailing address
1717 W COWLES ST, FAIRBANKS, AK 99701-5926
(907) 451-6682
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3927
AK
Other
Enumeration date
01/08/2015
Last updated
01/08/2015
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