Provider Demographics
NPI:1164577037
Name:FINK, SIEGFRIED A (PHD)
Entity Type:Individual
Prefix:
First Name:SIEGFRIED
Middle Name:A
Last Name:FINK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 CHENA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-2403
Mailing Address - Country:US
Mailing Address - Phone:907-457-4614
Mailing Address - Fax:907-457-4614
Practice Address - Street 1:688 CHENA RIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2403
Practice Address - Country:US
Practice Address - Phone:907-457-4614
Practice Address - Fax:907-457-4614
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPS0371Medicaid
AKPS0371Medicaid