Healthcare Provider Details

I. General information

NPI: 1780595090
Provider Name (Legal Business Name): KRISTINA JANEAN DICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E TUDOR RD # 105
ANCHORAGE AK
99503-7457
US

IV. Provider business mailing address

701 E TUDOR RD # 105
ANCHORAGE AK
99503-7457
US

V. Phone/Fax

Practice location:
  • Phone: 907-334-9001
  • Fax: 907-868-8557
Mailing address:
  • Phone: 907-334-9001
  • Fax: 907-868-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: