Provider Demographics
NPI:1689084733
Name:KASSMAN, JAIMIE LYNN
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:LYNN
Last Name:KASSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:MCCANN TREATMENT CENTER
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-1029
Mailing Address - Country:US
Mailing Address - Phone:907-543-6800
Mailing Address - Fax:907-543-7101
Practice Address - Street 1:833 CHEIF EDDIE HOFFMAN HWY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-543-2762
Practice Address - Fax:907-543-3152
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1004541Medicaid
AK1002447Medicaid
AK1584987Medicaid