Provider Demographics
NPI:1184010738
Name:SJOSTEDT, MARY (AUD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SJOSTEDT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 GLACIER HWY STE 116
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8079
Mailing Address - Country:US
Mailing Address - Phone:907-789-6780
Mailing Address - Fax:
Practice Address - Street 1:8800 GLACIER HWY STE 116
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8079
Practice Address - Country:US
Practice Address - Phone:907-789-6780
Practice Address - Fax:907-789-5828
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101793231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist