Healthcare Provider Details

I. General information

NPI: 1629037684
Provider Name (Legal Business Name): MARIE KATHLEEN BATEMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 DEBARR RD SOCIAL & BEHAVIORAL HEALTH SERVICE
ANCHORAGE AK
99508-2983
US

IV. Provider business mailing address

2925 DEBARR RD SOCIAL & BEHAVIORAL HEALTH SERVICE
ANCHORAGE AK
99508-2983
US

V. Phone/Fax

Practice location:
  • Phone: 907-257-4850
  • Fax: 907-257-6747
Mailing address:
  • Phone: 907-257-4850
  • Fax: 907-257-6747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2772042501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: