Healthcare Provider Details

I. General information

NPI: 1801284047
Provider Name (Legal Business Name): STEPHANIE M MUSSELMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673D MDG 5955 ZEAMER AVENUE
JBER AK
99506-3700
US

IV. Provider business mailing address

673D MDG 5955 ZEAMER AVENUE
JBER AK
99506-3700
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-2181
  • Fax:
Mailing address:
  • Phone: 907-580-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1036
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: