Healthcare Provider Details

I. General information

NPI: 1386950988
Provider Name (Legal Business Name): JAEDON AVEY MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WEST 5TH AVENUE
NOME AK
99762-0966
US

IV. Provider business mailing address

306 WEST 5TH AVENUE
NOME AK
99762-0966
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3344
  • Fax: 907-443-5915
Mailing address:
  • Phone: 907-443-3344
  • Fax: 907-443-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: