MRS. KATHLEEN KETZLER DEMIENTIEFF T.C. C.D.C.1 NPI 1215187505

NPI Information

NPI: 1215187505
Provider Name: MRS. KATHLEEN KETZLER DEMIENTIEFF, T.C., C.D.C.1
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1027 EVERGREEN ST
FAIRBANKS, AK
ZIP 99709
Phone: (907) 451-8164
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MRS. Kathleen Ketzler Demientieff, T.C., C.D.C.1 is an addiction (substance use disorder) counselor in Fairbanks, AK. MRS. Kathleen Ketzler Demientieff, T.C., C.D.C.1 NPI is 1215187505. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1027 EVERGREEN ST
FAIRBANKS, AK
ZIP 99709-306
Phone: (907) 451-8164

The enumeration date for this NPI number is 9/24/2008 and was last updated on 9/24/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	3432	ALASKA	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	2920	ALASKA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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