Provider Demographics
NPI:1033639893
Name:MARCINKIEWICZ, KRYSTAL ANNE (MA, REGISTERED-INTER)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:ANNE
Last Name:MARCINKIEWICZ
Suffix:
Gender:F
Credentials:MA, REGISTERED-INTER
Other - Prefix:MS
Other - First Name:KRYSTAL
Other - Middle Name:ANNE
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16110 SW REGATTA LANE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:971-238-3216
Mailing Address - Fax:503-617-9379
Practice Address - Street 1:16110 SW REGATTA LANE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:971-238-3216
Practice Address - Fax:503-617-9379
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health