Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY00002555 | WA |
Y | 103TC0700X | Clinical Psychologist | PY00002555 | WA |
NPI | 1003863887 |
---|---|
Provider Name | Dr. Lucretia Hyzy Krebs |
First Address | Vancouver, WA 98661-4289 |
Second Address | Vancouver, WA 98661-4289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0178461 | L&I (01) | WA |
6029KR | REGENCE (01) | WA |
7118847 | (05) | WA |