Healthcare Provider Details

I. General information

NPI: 1124319058
Provider Name (Legal Business Name): NATALYA SKOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALYA KORNEEVA

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 S CUSHMAN ST
FAIRBANKS AK
99701-7530
US

IV. Provider business mailing address

136 FROG POND CIR
FAIRBANKS AK
99712-1244
US

V. Phone/Fax

Practice location:
  • Phone: 907-455-5304
  • Fax: 907-455-1460
Mailing address:
  • Phone: 907-458-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: