Provider Demographics
NPI:1306060462
Name:GREYWOLF, IVA (PHD)
Entity type:Individual
Prefix:DR
First Name:IVA
Middle Name:
Last Name:GREYWOLF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HALIBUT POINT ROAD #6
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-7011
Mailing Address - Country:US
Mailing Address - Phone:907-966-8776
Mailing Address - Fax:906-966-8864
Practice Address - Street 1:222 TONGASS DRIVE
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9835
Practice Address - Country:US
Practice Address - Phone:907-966-8776
Practice Address - Fax:907-966-8864
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical