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NPI Code Detail

MEDICARE: EMMA ROSE CRUTS

MEDICARE: EMMA ROSE CRUTS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1619846508
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA ROSE CRUTS
Provider Business Mailing Address
First Line : 5220 6TH STREET FRONTAGE RD E STE 1700
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-5771
Country : US
Telephone Number : 217-525-8332
Fax Number :
Provider Business Practice Location Address
First Line : 5425 SOUTHFIELD CTR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-5984
Country : US
Telephone Number : 217-525-8332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2025
Last Update Date : 10/30/2025

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Directions to “ EMMA ROSE CRUTS ” Practice Location

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