Healthcare Provider Details

I. General information

NPI: 1629493960
Provider Name (Legal Business Name): STEPHANIE DUSENBURY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 BUSINESS PARK BLVD
ANCHORAGE AK
99503-7174
US

IV. Provider business mailing address

4951 BUSINESS PARK BLVD
ANCHORAGE AK
99503-7174
US

V. Phone/Fax

Practice location:
  • Phone: 907-743-7200
  • Fax:
Mailing address:
  • Phone: 907-743-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1467775676
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: