Stephen L. Mailloux, PH. D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSYP539 Issued in AK

Practice address

800 East Dimond Blvd Suite 3-625
800 East Dimond Blvd Suite 3-625
Anchorage, AK 99515-2025

Phone

(907) 306-6525

NPI assigned

Nov 5, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Neuropsychological Services of Alaska, PC

  • Clinical Neuropsychologist
  • Anchorage, AK
  • NPI 1326204504
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1093995219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 EAST DIMOND BLVD SUITE 3-625",
            "address_2": "800 EAST DIMOND BLVD SUITE 3-625",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995152025",
            "telephone_number": "907-306-6525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 EAST DIMOND BLVD SUITE 3-625",
            "address_2": "800 EAST DIMOND BLVD SUITE 3-625",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995152025",
            "telephone_number": "907-306-6525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAILLOUX",
        "first_name": "STEPHEN",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "credential": "PH. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-05",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AK",
            "license": "539",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "AK",
            "license": "PSYP539",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "AK",
            "license": "PSYP539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maile Assisted Living Home
• Lawrence Jess Maile, PH.D.
• Kathy Eileen Mailelle
• Karen Mailer, MD
• Shannon Maillet
• Erin Chistine Main, OTR/L
• Patricia Main
• Amelia Victoria Mainord
• Mainsl Alaska LLC
• David Lynn Maisey, DDS

• Clinical Neuropsychologist in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Clinical Neuropsychologist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.