Provider Demographics
NPI:1346919404
Name:JEN SKAVHAUG
Entity Type:Organization
Organization Name:JEN SKAVHAUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:SKAVHAUG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-444-6693
Mailing Address - Street 1:6800 BRITTANY ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3998
Mailing Address - Country:US
Mailing Address - Phone:907-444-6693
Mailing Address - Fax:417-374-0271
Practice Address - Street 1:6800 BRITTANY ROCK WAY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3998
Practice Address - Country:US
Practice Address - Phone:907-444-6693
Practice Address - Fax:417-374-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty