Provider Demographics
NPI:1316965957
Name:MEDBURY, KAREN L (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:MEDBURY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57029
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-2029
Mailing Address - Country:US
Mailing Address - Phone:907-377-4727
Mailing Address - Fax:907-377-3690
Practice Address - Street 1:2630 CENTRAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:EIELSON AFB
Practice Address - State:AK
Practice Address - Zip Code:99702-2325
Practice Address - Country:US
Practice Address - Phone:907-377-4727
Practice Address - Fax:907-377-3690
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010609071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical