Healthcare Provider Details

I. General information

NPI: 1841321452
Provider Name (Legal Business Name): MIKKI EASLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/01/2024
Certification Date: 09/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13250 BADGER LN
ANCHORAGE AK
99516-3067
US

IV. Provider business mailing address

PO BOX 110481
ANCHORAGE AK
99511-0481
US

V. Phone/Fax

Practice location:
  • Phone: 907-290-2186
  • Fax: 907-519-6785
Mailing address:
  • Phone: 907-830-3759
  • Fax: 907-519-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1069
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAK

VII. Legacy identifiers

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

# 1
IdentifierCM5359
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: