Provider Demographics
NPI:1699985903
Name:STEVENSON, CHANDLER E (MS)
Entity type:Individual
Prefix:
First Name:CHANDLER
Middle Name:E
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MS
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 2949
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2949
Mailing Address - Country:US
Mailing Address - Phone:907-260-7300
Mailing Address - Fax:907-260-7301
Practice Address - Street 1:230 E MARYDALE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7648
Practice Address - Country:US
Practice Address - Phone:907-260-3691
Practice Address - Fax:907-260-3697
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1421041C0700X
WY681101Y00000X
AK909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor