Kolten W Brueggeman
Individual provider Active NPI Peer Specialist · Palmer, AK
NPI 1801477005 · NPPES record last updated Apr 19, 2021
Key facts
- NPI
- 1801477005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 11921 E Palmer Wasilla Hwy
Palmer, AK 99645-8833 - Phone
- (907) 745-2634
- NPI assigned
- Apr 19, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Co Occuring Disorders Institute | Past |
Accepting new patients | |
| Codi, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Yes |
Addresses
Primary practice location
11921 E Palmer Wasilla Hwy
Palmer, AK 99645-8833
Mailing address
PO Box 1907
Palmer, AK 99645-1907
Phone (907) 745-2634
Other providers in Palmer, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.