Healthcare Provider Details

I. General information

NPI: 1619296449
Provider Name (Legal Business Name): KIMBERLY ANN DAGGS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 04/15/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 KLAWOCK HOLLIS HIGHWAY
KLAWOCK AK
99925
US

IV. Provider business mailing address

PO BOX 69
KLAWOCK AK
99925-0069
US

V. Phone/Fax

Practice location:
  • Phone: 907-755-4986
  • Fax:
Mailing address:
  • Phone: 503-704-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number169088
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: