Basic Information
Provider Information
NPI: 1003156621
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KROMAN
FirstName: EMILY
MiddleName: ELIZABETH
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 271 WINSLOW WAY E UNIT 10405
Address2:  
City: BAINBRIDGE ISLAND
State: WA
PostalCode: 981109972
CountryCode: US
TelephoneNumber: 2069196546
FaxNumber:  
Practice Location
Address1: 4088 MATTSON PL NE
Address2:  
City: BAINBRIDGE ISLAND
State: WA
PostalCode: 981102224
CountryCode: US
TelephoneNumber: 2069196546
FaxNumber: 2064515681
Other Information
ProviderEnumerationDate: 02/19/2013
LastUpdateDate: 09/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X  Y Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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