MEDICARE: DR. LAURIE D JURASZEK PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1979	AL

General Provider Information

NPI Number	:	1740597590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE D JURASZEK PSY.D.

Provider Business Mailing Address
First Line	:	11901 BUSINESS BLVD STE 108
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7701
Country	:	US
Telephone Number	:	907-214-1181
Fax Number	:	907-215-2992

Provider Business Practice Location Address
First Line	:	11901 BUSINESS BLVD STE 108
Second Line	:
City	:	EAGLE RIVER
State	:	AK
Zip	:	99577-7701
Country	:	US
Telephone Number	:	907-214-1181
Fax Number	:	907-215-2992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	06/29/2022

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