Provider Demographics
NPI:1558789420
Name:DRAIS, TESSA
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:DRAIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 E PIONEER AVE STE 2
Mailing Address - Street 2:#2
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7571
Mailing Address - Country:US
Mailing Address - Phone:907-235-7683
Mailing Address - Fax:
Practice Address - Street 1:332 E PIONEER AVE STE 2
Practice Address - Street 2:#2
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7571
Practice Address - Country:US
Practice Address - Phone:907-235-7683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator