| Northern Psychology Resources Llc | |
|
215 Fidalgo Ave Kenai AK 99611-7751 | |
| (307) 335-4466 | |
| (907) 335-4467 |
| Full Name | Northern Psychology Resources Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 215 Fidalgo Ave, Kenai, Alaska |
| Authorized Official Name and Position | Jacqueline Dawn Bock (OWNER) |
| Authorized Official Contact | 9073354466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Psychology Resources Llc Po Box 1487 Kenai AK 99611-1487 Ph: (907) 335-4466 | Northern Psychology Resources Llc 215 Fidalgo Ave Kenai AK 99611-7751 Ph: (307) 335-4466 |
| NPI Number | 1104966183 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104966183 | NPI | - | NPPES |
| 1427095900 | Other | AK | INDIVIDUAL NPI |
| PS0561 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 561 (Alaska) | Primary |
| 103TC0700X | Psychologist - Clinical | 561 (Alaska) | Primary |
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