Provider Demographics
NPI:1417022963
Name:SELDEN, ANALISA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ANALISA
Middle Name:
Last Name:SELDEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 RIVER WATCH DR
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7354
Mailing Address - Country:US
Mailing Address - Phone:907-260-4827
Mailing Address - Fax:907-262-9422
Practice Address - Street 1:44539 STERLING HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7938
Practice Address - Country:US
Practice Address - Phone:907-260-9400
Practice Address - Fax:907-262-9422
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM8777Medicaid