Healthcare Provider Details

I. General information

NPI: 1013085364
Provider Name (Legal Business Name): SHELLEY LENEE REPPEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 LAKE OTIS PKWY SUITE 100
ANCHORAGE AK
99508-5209
US

IV. Provider business mailing address

3820 LAKE OTIS PKWY SUITE 100
ANCHORAGE AK
99508-5209
US

V. Phone/Fax

Practice location:
  • Phone: 907-569-6906
  • Fax: 907-569-6908
Mailing address:
  • Phone: 907-569-6906
  • Fax: 907-569-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number445
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: