Healthcare Provider Details

I. General information

NPI: 1831862655
Provider Name (Legal Business Name): STACEY LALEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY LALEAU

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559-4105
US

IV. Provider business mailing address

829 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559-4105
US

V. Phone/Fax

Practice location:
  • Phone: 907-543-6100
  • Fax:
Mailing address:
  • Phone: 907-543-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW007776
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: