Healthcare Provider Details

I. General information

NPI: 1659858587
Provider Name (Legal Business Name): CHLOE JANELLE ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 OAKLAHOMA ST. APT 2
ANCHORAGE AK
99504
US

IV. Provider business mailing address

511 OAKLAHOMA ST. APT 2
ANCHORAGE AK
99504
US

V. Phone/Fax

Practice location:
  • Phone: 907-306-8127
  • Fax:
Mailing address:
  • Phone: 907-306-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: