Healthcare Provider Details

I. General information

NPI: 1295056620
Provider Name (Legal Business Name): REBECCA L CROOKSTON P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 DRESSLER RD NW
CANTON OH
44718-2546
US

IV. Provider business mailing address

4510 DRESSLER RD NW
CANTON OH
44718-2546
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-5155
  • Fax: 330-494-6868
Mailing address:
  • Phone: 330-494-5155
  • Fax: 330-494-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0800052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: