Jacqueline Dawn Bock, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

561 Issued in AK

Practice address

215 Fidalgo Ave
Suite 104
Kenai, AK 99611-7751

Phone

(907) 335-4466

Fax

(907) 335-4467

NPI assigned

Jun 1, 2006

Sex

Female

Sole proprietor

Yes

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.

• Northern Psychology Resources LLC

  • Community/Behavioral Health Agency
  • Soldotna, AK
  • NPI 1124640024
  NPD Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2019 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 3, 2016.

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462233600000",
    "number": "1427095900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47294 PROGRESS CT",
            "address_2": "STE C",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996698322",
            "telephone_number": "907-262-4470",
            "fax_number": "907-262-4467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 FIDALGO AVE",
            "address_2": "SUITE 104",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996117751",
            "telephone_number": "907-335-4466",
            "fax_number": "907-335-4467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCK",
        "first_name": "JACQUELINE",
        "middle_name": "DAWN",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2016-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "AK",
            "license": "561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Twila J. Berry
• Kole Steven Bethke
• Beyond Limits Counseling
• Richard Dean Birch
• Rachelle Ann Blanc, DO
• Douglas Grant Boehme, PHARMD
• Roy H Boone Jr., MD
• Hailey A Bouton
• Christopher Bowers
• Ellen M Braband

• All providers in Kenai, AK
• Psychologist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.