Healthcare Provider Details

I. General information

NPI: 1548991979
Provider Name (Legal Business Name): CLAIR SPORTSMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E BENSON BLVD # 527
ANCHORAGE AK
99503-4019
US

IV. Provider business mailing address

PO BOX 7237
SURPRISE AZ
85374-0103
US

V. Phone/Fax

Practice location:
  • Phone: 907-921-7380
  • Fax:
Mailing address:
  • Phone: 907-921-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number225721
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: