Provider Demographics
NPI:1164821229
Name:CRONIN, ANGIE REATHER (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:REATHER
Last Name:CRONIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:NICOLE
Other - Last Name:REATHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:399 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3380
Mailing Address - Country:US
Mailing Address - Phone:541-868-2004
Mailing Address - Fax:
Practice Address - Street 1:399 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3380
Practice Address - Country:US
Practice Address - Phone:541-868-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1480103TC0700X
AK170357103TC0700X
OR3029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical