Provider Demographics
NPI:1679007355
Name:WEAVER, STEPHANIE I
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WEAVER
Suffix:I
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:P.O. BOX 59027
Mailing Address - Street 2:
Mailing Address - City:ST. MICHAEL
Mailing Address - State:AK
Mailing Address - Zip Code:99659-0659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ST. MICHAEL
Practice Address - State:AK
Practice Address - Zip Code:99659-0659
Practice Address - Country:US
Practice Address - Phone:907-923-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor