JIL DIANE BOTTRELL (NPI# 1770702524) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1770702524 |
Entity Type | Individual |
Full Name | JIL DIANE BOTTRELL |
Credential | PH.D. |
Practice Address |
600 University Ave Fairbanks AK 99709-3643 |
Mailing Address |
4054 Teal Ave Fairbanks AK 99709-3520 |
Practice Telephone | 9074574177 |
Mailing Telephone | 9074794177 |
Enumeration Date | 2007-04-24 |
Last Update Date | 2007-07-08 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
176 | AK | Behavioral Health & Social Service Providers |
Street Address |
600 UNIVERSITY AVE |
City | FAIRBANKS |
State | AK |
Zip Code | 99709-3643 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1396729174 | Michael J. Magowan | Marriage & Family Therapist | 600 University Ave, Suite 108, Fairbanks, AK 99709-3643 | 2005-12-05 |
1811474398 | Giles Andrew Hawthorn | Counselor | 600 University Ave, Fairbanks, AK 99709-3660 | 2018-07-26 |
1467979724 | Michael D Kolasa | Counselor | 600 University Ave, Ste 5, Fairbanks, AK 99709 | 2017-08-28 |
1932635216 | Kristen Erin Schupp | Massage Therapist | 600 University Ave, Suite 6d, Fairbanks, AK 99709-3660 | 2017-05-05 |
1649679564 | Kendra Campbell, Phd | Psychologist | 600 University Ave, Suite 2b, Fairbanks, AK 99709-3651 | 2014-08-15 |
1265863427 | Alaska Neuropsychological and Behavioral Health, LLC | Community/Behavioral Health | 600 University Ave, Suite 2 B, Fairbanks, AK 99709-3651 | 2013-12-12 |
1679805147 | Molly Leahy, Lpc, PC | Counselor | 600 University Ave, Fairbanks, AK 99701 | 2010-02-08 |
1629231568 | Wendy Hanford Arundale | Psychologist | 600 University Ave, Ste. 2, Fairbanks, AK 99709-3660 | 2008-07-09 |
1962602243 | Roy Glenn Watson | Social Worker | 600 University Ave, Fairbanks, AK 99709-3643 | 2007-07-24 |
1154530103 | Elizabeth D Jacobs | Speech-Language Pathologist | 600 University Ave, Ste. 110, Fairbanks, AK 99709-3643 | 2007-05-22 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1255946810 | Beacon Monitoring Professional Services | Technician, Other | 745 Staffordshire Rd, Fairbanks, AK 99709 | 2020-09-10 |
1235629544 | Fairbanks Healing Space | Health Educator | 3875 Geist Road, Suite E #136, Fairbanks, AK 99709 | 2018-05-11 |
1609395409 | Shawn K Goggins | Counselor | 1423 Peger Road, Fairbanks, AK 99709 | 2017-09-12 |
1710433347 | Jay Titus | Technician/Technologist | 2884 Marina Drive, Fairbanks, AK 99709 | 2016-09-01 |
1710391610 | Hannah Summerfelt | Dentist | 3539 Thomas St, Fairbanks, AK 99709 | 2014-06-18 |
1629407325 | Diane Louise Mitchell | Nurse Practitioner | 4650 Harvard Cir, Fairbanks, AK 99709 | 2013-11-04 |
1407147929 | Christina Martz | Counselor | 1270 Summet Drive, Fairbanks, AK 99709 | 2011-05-02 |
1255652285 | Surgery Center of Fairbanks LLC | Clinic/Center | 2310 Peger Road, Fairbanks, AK 99709 | 2010-06-14 |
1962661835 | John Leo Hughes Jr Jr. | Dentist | 3437 Airport Way, Suite 205, Fairbanks, AL 99709 | 2008-06-05 |
1508042417 | Katherine E Johnson, Md PC | Ophthalmology | 2485 Chief William Drive, Suite 100, Fairbanks, AK 99709 | 2008-01-10 |
Find all providers in zip 99709 |
Taxonomy Code | 103TB0200X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Psychologist |
Specialization | Cognitive & Behavioral |
Definition to come... |
Notes: [1/1/2007: title modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1881966414 | John Michael Worrall | Psychologist | 315 5th Ave, Fairbanks, AK 99701-5025 | 2012-01-27 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1699940171 | Joseph P. Bablonka | Psychologist | 2735 E Tudor Rd, Anchorage, AK 99507-1135 | 2008-04-25 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.