Provider Demographics
NPI:1558049189
Name:THE LISTEN LADY
Entity Type:Organization
Organization Name:THE LISTEN LADY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KACEA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BJORK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:907-203-6505
Mailing Address - Street 1:2521 E MTN VILLAGE DR
Mailing Address - Street 2:STE B PMB 709
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-203-6505
Mailing Address - Fax:
Practice Address - Street 1:231 E SWANSON AVE UNIT 33
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7056
Practice Address - Country:US
Practice Address - Phone:907-203-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty