Provider Information for 1902355167
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KATHLEEN EAGLE LPC
Sex: Female
NPI: 1902355167
Last Updated: 2021-05-28
Certification Date: 2021-05-28
Certification Date: 2021-05-28
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1902355167 | ||||||||
| Enumeration Date | 2016-09-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1276 BELUGA CT HOMER, AK 99603-7730 United States Phone: 907-435-7823 | Fax: | ||||||||
| Primary Practice Address | 1276 BELUGA CT HOMER, AK 99603-7730 United States Phone: 907-435-7823 | Fax: | ||||||||
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