Provider Demographics
NPI:1558920348
Name:WILLIAMS, ALICE SCOUT
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:SCOUT
Last Name:WILLIAMS
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 1:17639 TEDROW DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8215
Mailing Address - Country:US
Mailing Address - Phone:907-242-9442
Mailing Address - Fax:
Practice Address - Street 1:17639 TEDROW DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8215
Practice Address - Country:US
Practice Address - Phone:907-242-9442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKFORTHCOMING106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician