Healthcare Provider Details

I. General information

NPI: 1205750742
Provider Name (Legal Business Name): SALMA CONNELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SALMA TRUJILLO

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 ASPEN ST
FAIRBANKS AK
99709-5501
US

IV. Provider business mailing address

926 ASPEN ST
FAIRBANKS AK
99709-5501
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-1000
  • Fax:
Mailing address:
  • Phone: 907-563-1000
  • 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: