Healthcare Provider Details

I. General information

NPI: 1609574284
Provider Name (Legal Business Name): TIMOTHY AGUIRRE M.S. CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 BONIFACE PKWY
ANCHORAGE AK
99504-1038
US

IV. Provider business mailing address

9020 EMERALD DR # B
ANCHORAGE AK
99502-5131
US

V. Phone/Fax

Practice location:
  • Phone: 907-231-6268
  • Fax:
Mailing address:
  • Phone: 251-377-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number241655
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: