| NPI | 1164942314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBI S KOUSOULOS Practice Administrator 907-357-4543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103G00000X Clinical Neuropsychologist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2017-06-20 |