Healthcare Provider Details

I. General information

NPI: 1003747072
Provider Name (Legal Business Name): DEBORAH JEAN DUDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 OCONNOR RD
FAIRBANKS AK
99701-1575
US

IV. Provider business mailing address

825 OCONNOR RD
FAIRBANKS AK
99701-1575
US

V. Phone/Fax

Practice location:
  • Phone: 907-378-6091
  • Fax:
Mailing address:
  • Phone: 907-378-6091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3372881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: