Provider Demographics
NPI:1548984206
Name:JUNEAU MUSIC THERAPY LLC
Entity type:Organization
Organization Name:JUNEAU MUSIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:815-871-0214
Mailing Address - Street 1:PO BOX 20569
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99802-0569
Mailing Address - Country:US
Mailing Address - Phone:815-871-0214
Mailing Address - Fax:
Practice Address - Street 1:3010 BLUEBERRY HILLS RD S
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1988
Practice Address - Country:US
Practice Address - Phone:815-871-0214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty