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General NPI Number Information
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NPI Number | 1831531037
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Entity Type | Individual
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Provider Name | FRIDRIK RAFN GUDMUNDSSON L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 508 UPLAND ST
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City | KENAI
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State | AK
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Zip | 99611-8026
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Country | US
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Telephone | 907-335-7500
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Fax | 888-491-3243
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Provider Business Mailing Address
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Address Line | 48350 LAKESIDE AVE
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City | SOLDOTNA
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State | AK
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Zip | 99669-9125
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Country | US
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Telephone | 907-406-0509
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1252
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License Number State | AK
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