Provider Demographics
NPI:1538206842
Name:CROOKSTON, RAYMOND GARR (AUD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:GARR
Last Name:CROOKSTON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 LAKESHORE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2306
Mailing Address - Country:US
Mailing Address - Phone:510-444-9771
Mailing Address - Fax:510-444-9773
Practice Address - Street 1:3346 LAKESHORE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2306
Practice Address - Country:US
Practice Address - Phone:510-444-9771
Practice Address - Fax:510-444-9773
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2148237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter