Basic Information
| Provider Information | |||||||||
| NPI: | 1831531037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUDMUNDSSON | ||||||||
| FirstName: | FRIDRIK | ||||||||
| MiddleName: | RAFN | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 198 W RIVERVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077401321 | ||||||||
| FaxNumber: | 9072607301 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 E MARYDALE AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072607300 | ||||||||
| FaxNumber: | 9072607301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2013 | ||||||||
| LastUpdateDate: | 07/29/2013 | ||||||||
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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 | 1252 | AK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.