Healthcare Provider Details

I. General information

NPI: 1144812777
Provider Name (Legal Business Name): ALYCIA SLUSHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 04/21/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51310 TIMBER BAY COURT
HOMER AK
99603
US

IV. Provider business mailing address

PO BOX 876741
WASILLA AK
99687-6741
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-3250
  • Fax: 907-235-3251
Mailing address:
  • Phone: 907-373-4732
  • Fax: 907-746-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: