Individual
UNKNOWN OSHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SPEECH LANGUAGE PATH
Contact information
Practice address
1327 KALAKAKET ST, FAIRBANKS, AK 99709-4917
(907) 452-4517
Mailing address
1327 KALAKAKET ST, FAIRBANKS, AK 99709-4917
(907) 452-4517
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
374
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
235Z00000X
SPEECH-LANGUAGE PATHOLOGIST
AK
Enumeration date
01/17/2007
Last updated
04/11/2013
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