Provider Demographics
NPI:1497069892
Name:LANSDOWN, EMILIANNE (BSW)
Entity Type:Individual
Prefix:MS
First Name:EMILIANNE
Middle Name:
Last Name:LANSDOWN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 1ST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4803
Mailing Address - Country:US
Mailing Address - Phone:907-452-6434
Mailing Address - Fax:907-451-6598
Practice Address - Street 1:122 1ST AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4803
Practice Address - Country:US
Practice Address - Phone:907-452-6434
Practice Address - Fax:907-451-6598
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK251C0000XMedicaid