Provider Demographics
NPI:1548975717
Name:CRONK, TALIA SUE (PSYD)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:SUE
Last Name:CRONK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TALIA
Other - Middle Name:SUE
Other - Last Name:KRAVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:9340 NE 76TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3721
Mailing Address - Country:US
Mailing Address - Phone:360-253-4912
Mailing Address - Fax:360-253-5170
Practice Address - Street 1:9340 NE 76TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-3721
Practice Address - Country:US
Practice Address - Phone:360-253-4912
Practice Address - Fax:360-253-5170
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61013077103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical