Healthcare Provider Details

I. General information

NPI: 1063239655
Provider Name (Legal Business Name): SARALYN M CROSSEN PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11761 RIDGE RD
GRASS VALLEY CA
95945-5025
US

IV. Provider business mailing address

11645 RIDGE RD
GRASS VALLEY CA
95945-5024
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-4431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: