1326193079 NPI number — SHARON ANN LAKE LPC

Table of content: SHARON ANN LAKE LPC (NPI 1326193079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326193079 NPI number — SHARON ANN LAKE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKE
Provider First Name:
SHARON
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAMLEN
Provider Other First Name:
SHARON
Provider Other Middle Name:
ANN BAILEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326193079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8230 KIP 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:
99507-3245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-244-8872
Provider Business Mailing Address Fax Number:
907-563-3217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2509 EIDE ST.
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:
99503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-244-8872
Provider Business Practice Location Address Fax Number:
907-563-3217
Provider Enumeration Date:
01/24/2007

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 614 , 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)

  • Identifier: PENDING , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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