Basic Information
| Provider Information | |||||||||
| NPI: | 1164887964 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOLPMAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 89 BOX 8190 | ||||||||
| Address2: | |||||||||
| City: | TALKEETNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996769701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077332273 | ||||||||
| FaxNumber: | 9077331735 | ||||||||
| Practice Location | |||||||||
| Address1: | HC 89 BOX 8190 | ||||||||
| Address2: | |||||||||
| City: | TALKEETNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996769701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077332273 | ||||||||
| FaxNumber: | 9077331735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2015 | ||||||||
| LastUpdateDate: | 12/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSWS29 | AK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.