Provider Demographics
NPI:1154996643
Name:SARGINGER, ALISHA GWYNN
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:GWYNN
Last Name:SARGINGER
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 1:205 E DIMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1909
Mailing Address - Country:US
Mailing Address - Phone:661-524-1151
Mailing Address - Fax:
Practice Address - Street 1:200 W RIVERDANCE CIR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6393
Practice Address - Country:US
Practice Address - Phone:661-524-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK176204106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist