Provider Demographics
NPI:1174546618
Name:VANAIRSDALE, MARY LOU (MSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:VANAIRSDALE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 E 31ST AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3938
Mailing Address - Country:US
Mailing Address - Phone:907-333-2032
Mailing Address - Fax:
Practice Address - Street 1:6330 E 31ST AVE APT 3
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3938
Practice Address - Country:US
Practice Address - Phone:907-333-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor