Provider Demographics
NPI:1164821229
Name:CRONIN, ANGIE REATHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:REATHER
Last Name:CRONIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:NICOLE
Other - Last Name:REATHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2250 S WOODWORTH LOOP STE 202
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7457
Mailing Address - Country:US
Mailing Address - Phone:907-761-5800
Mailing Address - Fax:
Practice Address - Street 1:2250 S WOODWORTH LOOP STE 202
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7457
Practice Address - Country:US
Practice Address - Phone:907-761-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3029103TC0700X
MT1480103TC0700X
AK170357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical