Provider Demographics
NPI:1255770509
Name:CROSBY, CHARITY JOY-KLEBS (CMII)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:JOY-KLEBS
Last Name:CROSBY
Suffix:
Gender:F
Credentials:CMII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 JEFFERSON ST S STE 5
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1556
Mailing Address - Country:US
Mailing Address - Phone:218-639-5879
Mailing Address - Fax:
Practice Address - Street 1:318 JEFFERSON ST S STE 5
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1556
Practice Address - Country:US
Practice Address - Phone:218-639-5879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst