Provider Demographics
NPI:1770256877
Name:POWELL, SELAH J (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SELAH
Middle Name:J
Last Name:POWELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 ROUND TREE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-7017
Mailing Address - Country:US
Mailing Address - Phone:907-440-4354
Mailing Address - Fax:
Practice Address - Street 1:1130 W DIMOND BLVD STE B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1511
Practice Address - Country:US
Practice Address - Phone:907-229-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK181017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist