Individual
JOSEPHINE CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHW
Contact information
Practice address
1401 N 10TH AVE, STAYTON, OR 97383-1311
(541) 650-8304
Mailing address
1401 N 10TH AVE, STAYTON, OR 97383-1311
(503) 769-2175
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
THW000106362
OR
Other
Enumeration date
04/20/2022
Last updated
04/20/2022
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