Provider Demographics
NPI:1326204504
Name:PEDIATRIC NEUROPSYCHOLOGICAL SERVICES OF ALASKA, PC
Entity Type:Organization
Organization Name:PEDIATRIC NEUROPSYCHOLOGICAL SERVICES OF ALASKA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEONCE
Authorized Official - Last Name:MAILLOUX
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:907-306-6525
Mailing Address - Street 1:800 EAST DIMOND BLVD, STE 3-625
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2047
Mailing Address - Country:US
Mailing Address - Phone:907-306-6525
Mailing Address - Fax:907-929-3057
Practice Address - Street 1:800 EAST DIMOND BLVD, STE 3-625
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2047
Practice Address - Country:US
Practice Address - Phone:907-306-6525
Practice Address - Fax:907-929-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty