Healthcare Provider Details

I. General information

NPI: 1245701721
Provider Name (Legal Business Name): GERALDINE MARIE ROUSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11261 HILL DR
ANCHORAGE AK
99507-6145
US

IV. Provider business mailing address

11261 HILL DR
ANCHORAGE AK
99507-6145
US

V. Phone/Fax

Practice location:
  • Phone: 907-308-3856
  • Fax:
Mailing address:
  • Phone: 907-654-4179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number193132
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: