Basic Information
| Provider Information | |||||||||
| NPI: | 1487373767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NYAKO | ||||||||
| FirstName: | JESSICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 N CRUSEY ST STE B112 | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996547100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073575400 | ||||||||
| FaxNumber: | 9073575477 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 N CRUSEY ST STE B112 | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996547100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073575400 | ||||||||
| FaxNumber: | 9073575477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2022 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.