Provider Demographics
NPI:1376323717
Name:CRANFORD, GREG (CSA)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:CRANFORD
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 MARKET PL
Mailing Address - Street 2:PMB# 20
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-4908
Mailing Address - Country:US
Mailing Address - Phone:425-737-3865
Mailing Address - Fax:425-977-7775
Practice Address - Street 1:11422 137TH AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-9349
Practice Address - Country:US
Practice Address - Phone:425-737-3865
Practice Address - Fax:425-977-7775
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator