MEDICARE: JAZZMON CRAWFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1205784097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZZMON CRAWFORD

Provider Business Mailing Address
First Line	:	160 GLEN COVE MARINA RD E STE 102
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-7290
Country	:	US
Telephone Number	:	707-648-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 GLEN COVE MARINA RD E STE 102
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-7290
Country	:	US
Telephone Number	:	707-648-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “ JAZZMON CRAWFORD ” Practice Location

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