Provider Demographics
NPI:1295158988
Name:JETT, MICHELLE (AAS, CDC II, BHC II)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:JETT
Suffix:
Gender:F
Credentials:AAS, CDC II, BHC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 6TH AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2165
Mailing Address - Country:US
Mailing Address - Phone:907-677-7709
Mailing Address - Fax:907-677-7095
Practice Address - Street 1:4701 BUSINESS PARK BLVD STE J20
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7170
Practice Address - Country:US
Practice Address - Phone:907-677-7709
Practice Address - Fax:907-677-7095
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)