Provider Demographics
NPI:1184385015
Name:HOPPER, ANDREW VERN (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:VERN
Last Name:HOPPER
Suffix:
Gender:M
Credentials:LCSW
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 55634
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-0634
Mailing Address - Country:US
Mailing Address - Phone:907-651-7324
Mailing Address - Fax:907-416-2949
Practice Address - Street 1:250 CUSHMAN ST STE 2H
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4665
Practice Address - Country:US
Practice Address - Phone:907-651-7324
Practice Address - Fax:907-416-2949
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099312421041C0700X
AK2143021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1752670Medicaid