Provider Demographics
NPI:1952068785
Name:STRAIGHT, KOURTNEY NICOLE
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:NICOLE
Last Name:STRAIGHT
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 1:1689 S KNIK GOOSE BAY RD STE 700
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8088
Mailing Address - Country:US
Mailing Address - Phone:907-841-8663
Mailing Address - Fax:907-357-0115
Practice Address - Street 1:1689 S KNIK GOOSE BAY RD STE 700
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8088
Practice Address - Country:US
Practice Address - Phone:907-841-8663
Practice Address - Fax:907-357-0115
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker