Provider Demographics
NPI:1578265237
Name:CROSKEY, CORINNA
Entity Type:Individual
Prefix:
First Name:CORINNA
Middle Name:
Last Name:CROSKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEMORE
Mailing Address - State:OH
Mailing Address - Zip Code:44250-9544
Mailing Address - Country:US
Mailing Address - Phone:330-604-9272
Mailing Address - Fax:
Practice Address - Street 1:1587 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:LAKEMORE
Practice Address - State:OH
Practice Address - Zip Code:44250-9544
Practice Address - Country:US
Practice Address - Phone:330-604-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000XS.003618175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist