Provider Demographics
NPI:1124682091
Name:WEGELEBEN, AUBREY (CDCI, ABHC)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:WEGELEBEN
Suffix:
Gender:F
Credentials:CDCI, ABHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:AK
Mailing Address - Zip Code:99660-0086
Mailing Address - Country:US
Mailing Address - Phone:907-546-3200
Mailing Address - Fax:907-546-3254
Practice Address - Street 1:1000 POLOVINA TURNPIKE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:AK
Practice Address - Zip Code:99660
Practice Address - Country:US
Practice Address - Phone:907-546-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3812101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)