Provider Demographics
NPI:1104999200
Name:CROOKSTON, GARR J (AUD)
Entity type:Individual
Prefix:DR
First Name:GARR
Middle Name:J
Last Name:CROOKSTON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2314 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4514
Mailing Address - Country:US
Mailing Address - Phone:510-865-8113
Mailing Address - Fax:510-865-8115
Practice Address - Street 1:2314 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4514
Practice Address - Country:US
Practice Address - Phone:510-865-8113
Practice Address - Fax:510-865-8115
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108267-4101237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00001814488-05OtherUHC