Provider Demographics
NPI:1174997977
Name:CROSBY, EMMA C
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:C
Last Name:CROSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 KELLOGG ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1673
Mailing Address - Country:US
Mailing Address - Phone:616-450-2606
Mailing Address - Fax:
Practice Address - Street 1:13500 SE 7TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-6909
Practice Address - Country:US
Practice Address - Phone:360-699-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61052535104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker