Provider Demographics
NPI:1174544225
Name:MICHAUD, LOIS I (PHD)
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:I
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LOIS
Other - Middle Name:I
Other - Last Name:MICHAUD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2207 SPENARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1617
Mailing Address - Country:US
Mailing Address - Phone:907-222-7740
Mailing Address - Fax:907-222-7740
Practice Address - Street 1:2207 SPENARD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-1617
Practice Address - Country:US
Practice Address - Phone:907-222-7740
Practice Address - Fax:907-222-7740
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK153371Medicare ID - Type Unspecified