Provider Demographics
NPI:1891857983
Name:TAKAGI, JUNKO (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUNKO
Middle Name:
Last Name:TAKAGI
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:PO BOX 110093
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0093
Mailing Address - Country:US
Mailing Address - Phone:907-727-8224
Mailing Address - Fax:907-333-2428
Practice Address - Street 1:1803 KEPNER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3061
Practice Address - Country:US
Practice Address - Phone:907-727-8224
Practice Address - Fax:855-833-1069
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKSLP47235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1031128Medicaid
AKSP1907Medicaid
AK203597089OtherTAX ID