Healthcare Provider Details

I. General information

NPI: 1588432967
Provider Name (Legal Business Name): KRISTINA KAREN WELTZIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 12/15/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 MENDENHALL LOOP RD.
JUNEAU AK
99801
US

IV. Provider business mailing address

PO BOX 210792
AUKE BAY AK
99821-0792
US

V. Phone/Fax

Practice location:
  • Phone: 907-723-6522
  • Fax:
Mailing address:
  • Phone: 907-723-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSWS321
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: