MEDICARE: DEBORAH CROCKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	LD00004185	WA

General Provider Information

NPI Number	:	1356525356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH CROCKER

Provider Business Mailing Address
First Line	:	5000 CHESHIRE LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-3706
Country	:	US
Telephone Number	:	888-333-9152
Fax Number	:	763-268-4240

Provider Business Practice Location Address
First Line	:	19720 68TH AVE W
Second Line	:	SUITE C
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-4568
Country	:	US
Telephone Number	:	425-744-0891
Fax Number	:	425-775-4449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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Directions to “ DEBORAH CROCKER ” Practice Location

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