Provider Demographics
NPI:1922130566
Name:REDELFS, ESPERANZA M (CSW)
Entity Type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:M
Last Name:REDELFS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:ESPERANZA
Other - Middle Name:M
Other - Last Name:REDELFS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW
Mailing Address - Street 1:2960 TONGASS AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5742
Mailing Address - Country:US
Mailing Address - Phone:907-228-4902
Mailing Address - Fax:907-228-5256
Practice Address - Street 1:2960 TONGASS AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5742
Practice Address - Country:US
Practice Address - Phone:907-228-4902
Practice Address - Fax:907-228-5256
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK251OtherLICENSED SOCIAL WORKER