| NPI | 1104966183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE DAWN BOCK Owner 907-335-4466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AK 561) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AK 561) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2025-09-11 |