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General NPI Number Information
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NPI Number | 1568935245
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Entity Type | Organization
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Legal Business Name | KENNETH G YOUNGBERG PC
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Dates
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Enumeration Date | 01/06/2019
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Last Update Date | 01/06/2019
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Provider Practice Location Address
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Address Line | 232 W ROCKWELL AVE
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City | SOLDOTNA
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State | AK
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Zip | 99669-7411
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Country | US
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Telephone | 907-953-7303
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Fax |
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Provider Business Mailing Address
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Address Line | 47360 PHILOSOPHER CT
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City | SOLDOTNA
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State | AK
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Zip | 99669-9259
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Country | US
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Telephone | 907-953-7303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH G YOUNGBERG
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Credential | LCSW
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Telephone | 907-953-7303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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