Provider Demographics
NPI:1891736344
Name:MACOMBER, HEATHER H (PHD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:H
Last Name:MACOMBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4241 B ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5920
Mailing Address - Country:US
Mailing Address - Phone:907-277-0100
Mailing Address - Fax:907-222-0566
Practice Address - Street 1:4241 B ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5920
Practice Address - Country:US
Practice Address - Phone:907-277-0100
Practice Address - Fax:907-222-0566
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK559103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPS9086Medicaid