1023247384 NPI number — KRISTINA GUTGESELL BOSWOOD M.ED, LPC

Table of content: KRISTINA GUTGESELL BOSWOOD M.ED, LPC (NPI 1023247384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023247384 NPI number — KRISTINA GUTGESELL BOSWOOD M.ED, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOSWOOD
Provider First Name:
KRISTINA
Provider Middle Name:
GUTGESELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOSWOOD
Provider Other First Name:
KRISTEL
Provider Other Middle Name:
GUTGESELL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED, LPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023247384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 1ST AVE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99701-4803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-452-8251
Provider Business Mailing Address Fax Number:
907-459-3810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-8251
Provider Business Practice Location Address Fax Number:
907-459-3810
Provider Enumeration Date:
07/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PCO P 735 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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