Healthcare Provider Details

I. General information

NPI: 1154985240
Provider Name (Legal Business Name): TONI KRISTINA MONAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 DIMOND D CIR
ANCHORAGE AK
99515-1931
US

IV. Provider business mailing address

7252 FOXRIDGE CIR APT G
ANCHORAGE AK
99518-2708
US

V. Phone/Fax

Practice location:
  • Phone: 907-771-0536
  • Fax:
Mailing address:
  • Phone: 907-748-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number179146
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: