Provider Demographics
NPI:1154985240
Name:MONAHAN, TONI KRISTINA
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:KRISTINA
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7252 FOXRIDGE CIR APT G
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2708
Mailing Address - Country:US
Mailing Address - Phone:907-748-7323
Mailing Address - Fax:
Practice Address - Street 1:8717 DIMOND D CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1931
Practice Address - Country:US
Practice Address - Phone:907-771-0536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK179146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program