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General NPI Number Information
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NPI Number | 1598803702
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Entity Type | Individual
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Provider Name | PAT ALTON TRUESDELL LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 43335 KALIFORNSKY BEACH RD SUITE 3B
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City | SOLDOTNA
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State | AK
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Zip | 99669-8260
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Country | US
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Telephone | 907-260-3745
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Fax | 907-260-3746
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Provider Business Mailing Address
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Address Line | PO BOX 1452
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City | SOLDOTNA
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State | AK
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Zip | 99669-1452
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Country | US
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Telephone | 907-260-3745
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Fax | 907-260-3746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 728
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License Number State | AK
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