Healthcare Provider Details

I. General information

NPI: 1275829772
Provider Name (Legal Business Name): JEANNE CRABTREE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8304 GUIDE MERIDIAN RD
LYNDEN WA
98264-9151
US

IV. Provider business mailing address

PO BOX 13
LYNDEN WA
98264-0013
US

V. Phone/Fax

Practice location:
  • Phone: 360-354-6610
  • Fax: 360-318-8918
Mailing address:
  • Phone: 360-354-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5683
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number5683
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: