Healthcare Provider Details

I. General information

NPI: 1912134156
Provider Name (Legal Business Name): ERIN L IWAMOTO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E 36TH AVE
ANCHORAGE AK
99508-4372
US

IV. Provider business mailing address

PO BOX 4105
PORTLAND OR
97208-4105
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-9229
  • Fax: 907-562-1603
Mailing address:
  • Phone: 866-907-1068
  • Fax: 425-917-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number136404
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: