Provider Demographics
NPI:1336865393
Name:HEYANO, JOSIE ELLEN
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:ELLEN
Last Name:HEYANO
Suffix:
Gender:F
Credentials:
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 90539
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-0539
Mailing Address - Country:US
Mailing Address - Phone:907-251-7926
Mailing Address - Fax:
Practice Address - Street 1:SOUTH CENTRAL FOUNDATION
Practice Address - Street 2:400 WEST BENSON
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-251-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK196745104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker