Healthcare Provider Details

I. General information

NPI: 1831531037
Provider Name (Legal Business Name): FRIDRIK RAFN GUDMUNDSSON L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 UPLAND ST
KENAI AK
99611-8026
US

IV. Provider business mailing address

48350 LAKESIDE AVE
SOLDOTNA AK
99669-9125
US

V. Phone/Fax

Practice location:
  • Phone: 907-335-7500
  • Fax: 888-491-3243
Mailing address:
  • Phone: 907-406-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1252
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: