Provider Demographics
NPI:1396791554
Name:CRAWFORD, ANDREA J (LMP, LMT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMP, LMT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:J
Other - Last Name:KLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP, LMT
Mailing Address - Street 1:22809 NE 223RD ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-5066
Mailing Address - Country:US
Mailing Address - Phone:360-601-5206
Mailing Address - Fax:360-635-4429
Practice Address - Street 1:316 E FOURTH PLAIN BLVD
Practice Address - Street 2:STE. B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3074
Practice Address - Country:US
Practice Address - Phone:360-601-5206
Practice Address - Fax:360-635-4429
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015927225700000X
OR8074225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist