Provider Demographics
NPI:1164942314
Name:PTARMIGAN CONNECTIONS, LLC
Entity Type:Organization
Organization Name:PTARMIGAN CONNECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOUSOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-4543
Mailing Address - Street 1:3543 E MERIDIAN PARK LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7294
Mailing Address - Country:US
Mailing Address - Phone:907-357-4543
Mailing Address - Fax:
Practice Address - Street 1:3505 E MERIDIAN PARK LOOP
Practice Address - Street 2:SUITE 200
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-4543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty