Healthcare Provider Details

I. General information

NPI: 1396490405
Provider Name (Legal Business Name): TANIESH AMON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANIESH LUE

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 DIPLOMACY DR
ANCHORAGE AK
99508-5910
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-8880
  • Fax:
Mailing address:
  • Phone: 907-729-3300
  • Fax: 907-729-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number184612
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number184612
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number184612
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: