Provider Demographics
NPI:1093061038
Name:CRABB, BEAU AMADEUS (MS, CGC)
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:AMADEUS
Last Name:CRABB
Suffix:
Gender:M
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CHICAGO AVE
Mailing Address - Street 2:CSC-560
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4289
Mailing Address - Country:US
Mailing Address - Phone:612-813-6544
Mailing Address - Fax:612-813-6360
Practice Address - Street 1:2530 CHICAGO AVE
Practice Address - Street 2:CSC-560
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4289
Practice Address - Country:US
Practice Address - Phone:612-813-6544
Practice Address - Fax:612-813-6360
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS