Provider Demographics
NPI:1689470759
Name:CROSSLEY, ANNIKA L (CD)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:L
Last Name:CROSSLEY
Suffix:
Gender:
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E RACINE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-4830
Mailing Address - Country:US
Mailing Address - Phone:608-754-3722
Mailing Address - Fax:608-754-3132
Practice Address - Street 1:32 E RACINE ST STE 150
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-4830
Practice Address - Country:US
Practice Address - Phone:608-754-3722
Practice Address - Fax:608-754-3132
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3352-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered