Healthcare Provider Details

I. General information

NPI: 1396791554
Provider Name (Legal Business Name): ANDREA J. CRAWFORD LMP, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA J. KLINGER LMP, LMT

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E FOURTH PLAIN BLVD STE. B
VANCOUVER WA
98663-3074
US

IV. Provider business mailing address

22809 NE 223RD ST
BATTLE GROUND WA
98604-5066
US

V. Phone/Fax

Practice location:
  • Phone: 360-601-5206
  • Fax: 360-635-4429
Mailing address:
  • Phone: 360-601-5206
  • Fax: 360-635-4429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00015927
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8074
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: