Individual
MRS. ALEJANDRINA MARIA MALLET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
772 KARLUK CT, FAIRBANKS, AK 99701-1407
(856) 982-9294
Mailing address
300 W SWANSON AVE, WASILLA, AK 99654-6844
(907) 841-6377
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1555769594
TRICARE
AK
Enumeration date
07/10/2019
Last updated
10/05/2020
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