Provider Demographics
NPI:1851944789
Name:TOTLAND, KATLYN JADE
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:JADE
Last Name:TOTLAND
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:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0090
Mailing Address - Country:US
Mailing Address - Phone:907-766-6313
Mailing Address - Fax:
Practice Address - Street 1:16 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827
Practice Address - Country:US
Practice Address - Phone:907-766-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator