Provider Demographics
NPI:1922749746
Name:STILTON, ADELLE ELIZABETH APRIL-MARI
Entity Type:Individual
Prefix:MRS
First Name:ADELLE
Middle Name:ELIZABETH APRIL-MARI
Last Name:STILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADELLE
Other - Middle Name:ELIZABETH APRIL-MARI
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1520 BARANOF ST
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6521
Mailing Address - Country:US
Mailing Address - Phone:803-995-0393
Mailing Address - Fax:
Practice Address - Street 1:1520 BARANOF ST
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6521
Practice Address - Country:US
Practice Address - Phone:803-995-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7817009106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician