| Doctor Name: | DALE FORMAN |
| NPI Number: | 1023432457 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 0-13-5716 |
| Business Practice Address: | 12836 Old Glenn Hwy Eagle River, AK - 995777041 |
| Business Phone Number: | 9077265330 |
| Business Fax Number: | |
| Mailing Address: | 13541 Charmley Cir, EAGLE RIVER |
| State: | AK |
| Postal Code: | 99577 |
| Phone Number: | 3346854506 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2014 |
| NPI Last Update Date: | 02/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103K00000X |
| License Number: | 0-13-5716 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Behavioral Analyst |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Behavior Analyst is a practitioner who specializes in analysis of behavior problems and development of appropriate intervention and treatment plans. A Behavior Analyst may work independently or with a team of professionals. Behavior Analysts often specialize in a particular area such as autism, developmental disabilities, mental health, geriatrics, or head trauma. |