Provider Demographics
NPI:1184020513
Name:MOSHER, MARLA
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:MOSHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-1907
Mailing Address - Country:US
Mailing Address - Phone:907-745-2634
Mailing Address - Fax:907-745-4897
Practice Address - Street 1:11921 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8833
Practice Address - Country:US
Practice Address - Phone:907-745-2634
Practice Address - Fax:907-745-4897
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker