| Doctor Name: | DESIREE NIEDERER |
| NPI Number: | 1164817169 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P.C. |
| License Number: | 790 |
| Business Practice Address: | 17105 Park Place St Eagle River, AK - 995777821 |
| Business Phone Number: | 9076221002 |
| Business Fax Number: | 9076228808 |
| Mailing Address: | 17105 Park Place St, EAGLE RIVER |
| State: | AK |
| Postal Code: | 995777821 |
| Phone Number: | 9076221002 |
| Fax Number: | 9076228808 |
| NPI Enumeration Date: | 04/06/2015 |
| NPI Last Update Date: | 04/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 790 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |