Provider Demographics
NPI:1023384641
Name:KATCHEAK, TIA (CHA III)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:
Last Name:KATCHEAK
Suffix:
Gender:F
Credentials:CHA III
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:SNOWBALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:STEBBINS
Mailing Address - State:AK
Mailing Address - Zip Code:99671-0500
Mailing Address - Country:US
Mailing Address - Phone:907-934-3311
Mailing Address - Fax:907-934-3312
Practice Address - Street 1:50 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:STEBBINS
Practice Address - State:AK
Practice Address - Zip Code:99671-0500
Practice Address - Country:US
Practice Address - Phone:907-934-3311
Practice Address - Fax:907-934-3312
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12-1167-III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK12-1167-IIIOtherCHA III