Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 128383 | AK |
NPI | 1003382706 |
---|---|
Provider Name | Mrs. Rebecca Ann Shestakov |
First Address | Anchorage, AK 99511-1287 |
Second Address | Anchorage, AK 99502-2809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2018 |
Last Update Date | 19/10/2018 |