Provider Demographics
NPI:1528025400
Name:CRABB, ANN E (PHD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:CRABB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7895 CURRIER DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-4314
Mailing Address - Country:US
Mailing Address - Phone:269-321-7034
Mailing Address - Fax:269-321-7095
Practice Address - Street 1:7895 CURRIER DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4314
Practice Address - Country:US
Practice Address - Phone:269-321-7034
Practice Address - Fax:269-321-7095
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003510101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6130490Medicaid