Healthcare Provider Details

I. General information

NPI: 1891745584
Provider Name (Legal Business Name): WENDY A CHASE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 LAKE OTIS PKWY SUITE 200
ANCHORAGE AK
99508-5234
US

IV. Provider business mailing address

PO BOX 196276
ANCHORAGE AK
99519-6276
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-6900
  • Fax:
Mailing address:
  • Phone: 907-212-6522
  • Fax: 907-212-6593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number46
License Number StateAK

VII. Legacy identifiers

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

# 1
IdentifierMH3148
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: