Provider Demographics
NPI:1356919161
Name:CARNCROSS, NATALEE
Entity type:Individual
Prefix:
First Name:NATALEE
Middle Name:
Last Name:CARNCROSS
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 1:2321 SUNNY LN APT I
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7812
Mailing Address - Country:US
Mailing Address - Phone:217-549-0626
Mailing Address - Fax:
Practice Address - Street 1:986 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:WI
Practice Address - Zip Code:54313-8818
Practice Address - Country:US
Practice Address - Phone:920-409-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst