Provider Demographics
NPI:1154726537
Name:HEDGSPETH, CHAZ MALIK
Entity type:Individual
Prefix:
First Name:CHAZ
Middle Name:MALIK
Last Name:HEDGSPETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 INDEPENDENCE DR
Mailing Address - Street 2:APT 314
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4691
Mailing Address - Country:US
Mailing Address - Phone:907-538-3356
Mailing Address - Fax:
Practice Address - Street 1:110 MULDOON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1403
Practice Address - Country:US
Practice Address - Phone:907-762-8625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health