MEDICARE: DR. ELLEN COLE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	431	AK

General Provider Information

NPI Number	:	1962608323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN COLE PHD

Provider Business Mailing Address
First Line	:	4101 UNIVERSITY DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4625
Country	:	US
Telephone Number	:	907-564-8216
Fax Number	:	907-564-8396

Provider Business Practice Location Address
First Line	:	4101 UNIVERSITY DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4625
Country	:	US
Telephone Number	:	907-564-8216
Fax Number	:	907-564-8396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. ELLEN COLE PHD” Practice Location

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