Healthcare Provider Details

I. General information

NPI: 1528335528
Provider Name (Legal Business Name): PAULINE ANN RICHARD L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12159 N. JONESVILLE MINE RD.
SUTTON AK
99674-0132
US

IV. Provider business mailing address

PO BOX 132
SUTTON AK
99674-0132
US

V. Phone/Fax

Practice location:
  • Phone: 907-746-7521
  • Fax: 907-746-7531
Mailing address:
  • Phone: 907-746-7521
  • Fax: 907-746-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1074
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: