Provider Demographics
NPI:1669131983
Name:PELOWOOK, DOMINIK
Entity type:Individual
Prefix:
First Name:DOMINIK
Middle Name:
Last Name:PELOWOOK
Suffix:
Gender:M
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 530
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:AK
Mailing Address - Zip Code:99783-0530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 RAZORBACK ROAD
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:AK
Practice Address - Zip Code:99783-0543
Practice Address - Country:US
Practice Address - Phone:907-664-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)