Provider Demographics
NPI:1285872317
Name:HENDRICKSON, RAE ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:RAE
Middle Name:ANN
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 E PILGRIM CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7824
Mailing Address - Country:US
Mailing Address - Phone:907-357-6513
Mailing Address - Fax:907-357-6514
Practice Address - Street 1:5730 E PILGRIM CT
Practice Address - Street 2:SUITE A
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7824
Practice Address - Country:US
Practice Address - Phone:907-357-6513
Practice Address - Fax:907-357-6514
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2373101YA0400X
AK558101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health