1174920334 NPI number — DR. LAHELA ASHLEE RICE JORGENSON PSYD

Table of content: DR. LAHELA ASHLEE RICE JORGENSON PSYD (NPI 1174920334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174920334 NPI number — DR. LAHELA ASHLEE RICE JORGENSON PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORGENSON
Provider First Name:
LAHELA
Provider Middle Name:
ASHLEE RICE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NISHIGAYA RICE
Provider Other First Name:
LAHELA
Provider Other Middle Name:
ASHLEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174920334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4112 HOOD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99517-1057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-787-9435
Provider Business Mailing Address Fax Number:
907-802-6111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4112 HOOD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99517-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-787-9435
Provider Business Practice Location Address Fax Number:
907-802-6111
Provider Enumeration Date:
12/03/2014

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: 103T00000X , with the licence number:  141062 , 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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