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General NPI Number Information
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NPI Number | 1629206016
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Entity Type | Individual
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Provider Name | GARY M WEGLARZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 2770 SHERWOOD LN SUITE 2-C
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City | JUNEAU
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State | AK
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Zip | 99801-8545
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Country | US
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Telephone | 907-321-7852
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 210536
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City | AUKE BAY
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State | AK
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Zip | 99821-0536
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Country | US
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Telephone | 907-789-0146
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 900-LCSW
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License Number State | AK
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