Healthcare Provider Details

I. General information

NPI: 1558049189
Provider Name (Legal Business Name): THE LISTEN LADY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E SWANSON AVE UNIT 33
WASILLA AK
99654-7056
US

IV. Provider business mailing address

2521 E MTN VILLAGE DR STE B PMB 709
WASILLA AK
99654
US

V. Phone/Fax

Practice location:
  • Phone: 907-203-6505
  • Fax:
Mailing address:
  • Phone: 907-203-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. KACEA JEAN BJORK
Title or Position: OWNER
Credential: MA
Phone: 907-203-6505