MEDICARE: REBECCA CANDICE CROSETTO M.G.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)	GT60204050	WA

General Provider Information

NPI Number	:	1043482532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA CANDICE CROSETTO M.G.C.

Provider Business Mailing Address
First Line	:	3600 LIND AVE SW
Second Line	:	SUITE 100 ATTN CREDENTIALING
City	:	RENTON
State	:	WA
Zip	:	98057
Country	:	US
Telephone Number	:	425-690-3477
Fax Number	:	425-690-9477

Provider Business Practice Location Address
First Line	:	4033 TALBOT RD S STE 450
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5767
Country	:	US
Telephone Number	:	425-690-3477
Fax Number	:	425-690-9477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	02/01/2022

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