Healthcare Provider Details

I. General information

NPI: 1457265878
Provider Name (Legal Business Name): KATHRYN JANE HEASLET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 PIPER ST STE 1108
ANCHORAGE AK
99508-4683
US

IV. Provider business mailing address

3760 PIPER ST STE 1108
ANCHORAGE AK
99508-4683
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-2014
  • Fax:
Mailing address:
  • Phone: 907-212-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: