Provider Demographics
NPI:1043482532
Name:CROSETTO, REBECCA CANDICE (MGC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:CANDICE
Last Name:CROSETTO
Suffix:
Gender:F
Credentials:MGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-690-3477
Mailing Address - Fax:425-690-9477
Practice Address - Street 1:4033 TALBOT RD S STE 450
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5767
Practice Address - Country:US
Practice Address - Phone:425-690-3477
Practice Address - Fax:425-690-9477
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAGT60204050170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS