Healthcare Provider Details

I. General information

NPI: 1124682091
Provider Name (Legal Business Name): AUBREY WEGELEBEN CDCI, ABHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 POLOVINA TURNPIKE
SAINT PAUL AK
99660
US

IV. Provider business mailing address

PO BOX 86
SAINT PAUL AK
99660-0086
US

V. Phone/Fax

Practice location:
  • Phone: 907-546-8300
  • Fax:
Mailing address:
  • Phone: 907-546-3200
  • Fax: 907-546-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3812
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: