Healthcare Provider Details

I. General information

NPI: 1730008343
Provider Name (Legal Business Name): DORRIEN HENDRICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 FIRST AVE
KETCHIKAN AK
99901-5803
US

IV. Provider business mailing address

PO BOX 7475
KETCHIKAN AK
99901-2475
US

V. Phone/Fax

Practice location:
  • Phone: 907-202-8684
  • Fax:
Mailing address:
  • Phone: 907-202-8684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: