Provider Demographics
NPI:1083870448
Name:ALASKA PREMIER THERAPY
Entity Type:Organization
Organization Name:ALASKA PREMIER THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHERNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:907-512-0979
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-0226
Mailing Address - Country:US
Mailing Address - Phone:907-512-0979
Mailing Address - Fax:
Practice Address - Street 1:204 E REZANOF DR
Practice Address - Street 2:LOWER #2
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6379
Practice Address - Country:US
Practice Address - Phone:907-512-0979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP16642Medicaid
AKSP16641Medicaid