Healthcare Provider Details

I. General information

NPI: 1851238265
Provider Name (Legal Business Name): TANIA V SILVA-JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 E REZANOF DR
KODIAK AK
99615-6601
US

IV. Provider business mailing address

PO BOX 751
KODIAK AK
99615-0751
US

V. Phone/Fax

Practice location:
  • Phone: 907-654-4575
  • Fax: 907-921-5119
Mailing address:
  • Phone: 907-654-4904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number212124
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: