MEDICARE: JESSICA CREW

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	104100000X	Social Worker	S.2504397-TRNE	OH

General Provider Information

NPI Number	:	1780420406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CREW

Provider Business Mailing Address
First Line	:	8261 MARKET ST
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6254
Country	:	US
Telephone Number	:	330-286-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	8261 MARKET ST
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-6254
Country	:	US
Telephone Number	:	330-286-0050
Fax Number	:

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

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	01/22/2026

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Directions to “ JESSICA CREW ” Practice Location

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