Healthcare Provider Details

I. General information

NPI: 1275925406
Provider Name (Legal Business Name): CRYSTAL SKOGLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 KEENE RD BLDG L
RICHLAND WA
99352-7751
US

IV. Provider business mailing address

6508 FENWAY DR
PASCO WA
99301-8985
US

V. Phone/Fax

Practice location:
  • Phone: 509-420-3442
  • Fax:
Mailing address:
  • Phone: 509-845-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: