Provider Demographics
NPI:1154790046
Name:CROSBY, KIMBERLEE MAE
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:MAE
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 1:1157 3RD AVE STE 218
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-6005
Mailing Address - Country:US
Mailing Address - Phone:360-952-3100
Mailing Address - Fax:360-952-3098
Practice Address - Street 1:1157 3RD AVE STE 218
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-6005
Practice Address - Country:US
Practice Address - Phone:360-952-3100
Practice Address - Fax:360-952-3098
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.60432843171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor