Healthcare Provider Details

I. General information

NPI: 1285234419
Provider Name (Legal Business Name): AMANDA PAULETTE ALGUIRE-GANNON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA GANNON LMSW

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 WATER ST STE 303
KETCHIKAN AK
99901-6378
US

IV. Provider business mailing address

3219 TIDE AVE
KETCHIKAN AK
99901-9627
US

V. Phone/Fax

Practice location:
  • Phone: 360-726-3108
  • Fax:
Mailing address:
  • Phone: 907-204-0874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number215055
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number215055
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: