Healthcare Provider Details

I. General information

NPI: 1235058082
Provider Name (Legal Business Name): CLAIRE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 BUSINESS BLVD STE 179
EAGLE RIVER AK
99577-7743
US

IV. Provider business mailing address

3435 N DAISY PETAL CIR
WASILLA AK
99654-1266
US

V. Phone/Fax

Practice location:
  • Phone: 907-726-1202
  • Fax:
Mailing address:
  • Phone: 907-414-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number256281
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: