Healthcare Provider Details

I. General information

NPI: 1982937645
Provider Name (Legal Business Name): QUINDOLA CROWLEY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MARVIN RD NE STE 305
LACEY WA
98516-5710
US

IV. Provider business mailing address

1401 MARVIN RD NE STE 305
LACEY WA
98516-5710
US

V. Phone/Fax

Practice location:
  • Phone: 360-402-7011
  • Fax: 360-455-7001
Mailing address:
  • Phone: 360-402-7011
  • Fax: 360-455-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00004063
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: