Healthcare Provider Details

I. General information

NPI: 1346661758
Provider Name (Legal Business Name): MARILYN CURTIS M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 REZANOF DR E
KODIAK AK
99615-6416
US

IV. Provider business mailing address

717 REZANOF DR E
KODIAK AK
99615-6416
US

V. Phone/Fax

Practice location:
  • Phone: 907-481-2400
  • Fax: 907-481-2419
Mailing address:
  • Phone: 907-481-2400
  • Fax: 907-481-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: