Healthcare Provider Details

I. General information

NPI: 1326376179
Provider Name (Legal Business Name): LORRAINE MELANIE CUTLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORRAINE MELANIE JAEGER-KIRSCH LCSW

II. Dates (important events)

Enumeration Date: 12/04/2009
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 W SPRUCE AVE
WASILLA AK
99654-5327
US

IV. Provider business mailing address

1363 W SPRUCE AVE
WASILLA AK
99654-5327
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-2411
  • Fax: 907-352-3363
Mailing address:
  • Phone: 73-762-4119
  • Fax: 73-352-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number344
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number844
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: