Healthcare Provider Details

I. General information

NPI: 1982884235
Provider Name (Legal Business Name): ALASKA SPEECH & HEARING CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E 42ND AVE #101
ANCHORAGE AK
99508-5391
US

IV. Provider business mailing address

2401 E 42ND AVE #101
ANCHORAGE AK
99508-5391
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-4550
  • Fax: 907-562-4554
Mailing address:
  • Phone: 907-562-4550
  • Fax: 907-562-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP7673
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU7673
License Number StateAK

VIII. Authorized Official

Name: MRS. LISA M OWENS
Title or Position: DIRECTOR
Credential: AUD
Phone: 907-562-4550