Provider Demographics
NPI:1124415989
Name:CHAPMAN, KATHRYN MARIE (MSW, CDCI)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MSW, CDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-2046
Mailing Address - Country:US
Mailing Address - Phone:907-321-1912
Mailing Address - Fax:
Practice Address - Street 1:9000 GLACIER HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8097
Practice Address - Country:US
Practice Address - Phone:907-321-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AK3986101YA0400X
AK1123671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical