Healthcare Provider Details

I. General information

NPI: 1710539549
Provider Name (Legal Business Name): MARGARET LOUISE KUGZRUK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 YOUNKER CT
FAIRBANKS AK
99701-7586
US

IV. Provider business mailing address

650 YOUNKER CT
FAIRBANKS AK
99701-7586
US

V. Phone/Fax

Practice location:
  • Phone: 907-456-1053
  • Fax: 907-456-2114
Mailing address:
  • Phone: 907-456-1053
  • Fax: 907-456-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104483
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: