Northern Psychology Resources LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

561 Issued in AK

Legal business name

NORTHERN PSYCHOLOGY RESOURCES LLC

Practice address

215 Fidalgo Ave
Kenai, AK 99611-7751

Phone

(307) 335-4466

Fax

(907) 335-4467

NPI assigned

Feb 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jacqueline Dawn Bock, PHD

Title

Owner

Phone

(907) 335-4466

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1104966183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1487",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996111487",
            "telephone_number": "907-335-4466",
            "fax_number": "907-335-4467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 FIDALGO AVE",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996117751",
            "telephone_number": "307-335-4466",
            "fax_number": "907-335-4467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN PSYCHOLOGY RESOURCES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BOCK",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-335-4466",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "AK",
            "license": "561",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "AK",
            "license": "561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1427095900",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PS0561",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.