Provider Demographics
NPI:1164516597
Name:PENDREY, JOHN W IV (CDCII, NCAC1)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:PENDREY
Suffix:IV
Gender:M
Credentials:CDCII, NCAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2620 MONMOUTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502
Mailing Address - Country:US
Mailing Address - Phone:907-273-4088
Mailing Address - Fax:907-273-4085
Practice Address - Street 1:3001 C STREET
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS DOMICILIARY
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-273-4000
Practice Address - Fax:907-273-4085
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2212101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)