Healthcare Provider Details

I. General information

NPI: 1033618418
Provider Name (Legal Business Name): CASSEY YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W COWLES ST
FAIRBANKS AK
99701-5926
US

IV. Provider business mailing address

PO BOX 94429
SEATTLE WA
98124-6729
US

V. Phone/Fax

Practice location:
  • Phone: 907-451-6682
  • Fax:
Mailing address:
  • Phone: 907-451-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: