Healthcare Provider Details

I. General information

NPI: 1205638434
Provider Name (Legal Business Name): ROBYN SOULE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WENDELL AVE
FAIRBANKS AK
99701-4837
US

IV. Provider business mailing address

940 BASKERVILLE ST
NORTH POLE AK
99705-5376
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-6251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255142
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: