Healthcare Provider Details

I. General information

NPI: 1629894092
Provider Name (Legal Business Name): KIRSTEN CROSBY BLOSE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W BRANDT BLVD
SALUNGA PA
17538-1105
US

IV. Provider business mailing address

888 SALISBURY CT
LANCASTER PA
17601-4481
US

V. Phone/Fax

Practice location:
  • Phone: 717-282-2908
  • Fax:
Mailing address:
  • Phone: 717-917-8166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW142248
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: