Provider Demographics
NPI:1013809987
Name:CROSEN, STEPHANIE JEAN
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEAN
Last Name:CROSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:SMITHGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:624 HARDINGS WHARF DR
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-3109
Mailing Address - Country:US
Mailing Address - Phone:571-226-7095
Mailing Address - Fax:
Practice Address - Street 1:624 HARDINGS WHARF DR
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3109
Practice Address - Country:US
Practice Address - Phone:571-226-7095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225CX0006X
VAPGP-06641902255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
No225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider