Healthcare Provider Details

I. General information

NPI: 1437951266
Provider Name (Legal Business Name): MICHAEL LEE MARDRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W PARKS HWY
WASILLA AK
99654-6953
US

IV. Provider business mailing address

4020 FOLKER ST
ANCHORAGE AK
99508-5386
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-1000
  • Fax:
Mailing address:
  • Phone: 907-563-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
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:
Title or Position:
Credential:
Phone: