Healthcare Provider Details

I. General information

NPI: 1750768610
Provider Name (Legal Business Name): JAIME SAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 LAKESHORE DR
ANCHORAGE AK
99517-2815
US

IV. Provider business mailing address

PO BOX 241224
ANCHORAGE AK
99524-1224
US

V. Phone/Fax

Practice location:
  • Phone: 907-374-7001
  • Fax: 907-374-7008
Mailing address:
  • Phone: 907-302-9164
  • Fax: 907-677-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number241534
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number119348
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: