Healthcare Provider Details

I. General information

NPI: 1538881305
Provider Name (Legal Business Name): KAYLAN CHACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8012 STEWART MOUNTAIN DR
EAGLE RIVER AK
99577-9013
US

IV. Provider business mailing address

2600 CORDOVA ST STE 101
ANCHORAGE AK
99503-2745
US

V. Phone/Fax

Practice location:
  • Phone: 907-694-3336
  • Fax:
Mailing address:
  • Phone: 907-279-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number252989
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: